Active NPI
Pavan Mahakala
- Pharmacist
- Dallas, TX
National Provider Identifier
1053647628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 45745
- Practice address
- 18207 Midway Rd
Dallas, TX 75287-4902 - Phone
- (972) 307-7556
- NPI assigned
- Nov 2, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 45745 | TX | Primary |
| Pharmacist | 183500000X | 5302035290 | MI |
Addresses
Primary practice location
18207 Midway Rd
Dallas, TX 75287-4902
Mailing address
18207 Midway Rd
Dallas, TX 75287-4902
Phone (972) 307-7556
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 |
|---|---|---|---|
| 5302035290 | MI | MD | Pharmacist |
| 45745 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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 and National Provider Directory roles.
-
- Pharmacy
- Dallas, TX
- NPI 1205841251
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257120000000",
"number": "1053647628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18207 MIDWAY RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752874902",
"telephone_number": "972-307-7556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18207 MIDWAY RD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752874902",
"telephone_number": "972-307-7556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHAKALA",
"first_name": "PAVAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-02",
"last_updated": "2009-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "45745",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302035290",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.