Active NPI
Kelly Gragert
- Pharmacy Technician
- Lake Jackson, TX
National Provider Identifier
1023773652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 104392
- Practice address
- 117 Oyster Creek Dr
Lake Jackson, TX 77566-4157 - Phone
- (979) 297-3254
- Fax
- (979) 297-9012
- NPI assigned
- Nov 8, 2021
- Last updated
- Nov 8, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 104392 | TX | Primary |
Addresses
Primary practice location
117 Oyster Creek Dr
Lake Jackson, TX 77566-4157
Mailing address
117 Oyster Creek Dr
Lake Jackson, TX 77566-4157
Phone (979) 297-3254
Other names 1
- Kelly Donovan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104392 | TX | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1023773652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 OYSTER CREEK DR",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775664157",
"telephone_number": "979-297-3254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 OYSTER CREEK DR",
"city": "LAKE JACKSON",
"state": "TX",
"postal_code": "775664157",
"telephone_number": "979-297-3254",
"fax_number": "979-297-9012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAGERT",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-08",
"last_updated": "2021-11-08",
"certification_date": "2021-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "TX",
"license": "104392",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "DONOVAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lake Jackson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.