Active NPI
Nebolisa Johnpaul Agupusi, PHARMD
- Pharmacist
- Longview, TX
National Provider Identifier
1053922930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 63423
- Practice address
- 1775 W Loop 281
Longview, TX 75604-2734 - Phone
- (903) 295-3526
- Fax
- (903) 295-3983
- NPI assigned
- Aug 13, 2020
- Last updated
- Aug 13, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 63423 | TX | Primary |
Addresses
Primary practice location
1775 W Loop 281
Longview, TX 75604-2734
Mailing address
5100 Sweetbriar LN Apt 612
Tyler, TX 75703-3866
Phone (773) 431-3039
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63423 | TX | MD | Clinical Social Worker |
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, 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": "1597276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597276800000",
"number": "1053922930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5100 SWEETBRIAR LN APT 612",
"city": "TYLER",
"state": "TX",
"postal_code": "757033866",
"telephone_number": "773-431-3039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 W LOOP 281",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756042734",
"telephone_number": "903-295-3526",
"fax_number": "903-295-3983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGUPUSI",
"first_name": "NEBOLISA",
"middle_name": "JOHNPAUL",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-13",
"last_updated": "2020-08-13",
"certification_date": "2020-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "63423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
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- Ak Fitness Health Center Inc. (dba,AK FITNESS THERAPY CENTER AND PROGRESSIVE MEDICAL)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.