Medi-Park Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

14575 Issued in TX

Legal business name

MEDI-PARK PHARMACY

Practice address

1920 Medi Park Dr
Amarillo, TX 79106-2104

Phone

(806) 359-5496

Fax

(806) 355-9533

NPI assigned

Sep 13, 2006

Last updated

Aug 6, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gerald Raymond Pandolfi, RPH.

Title

Owner-Pharmacist

Phone

(806) 359-5496

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1073618302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 MEDI PARK DR",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791062104",
            "telephone_number": "806-359-5496",
            "fax_number": "806-355-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 MEDI PARK DR",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791062104",
            "telephone_number": "806-359-5496",
            "fax_number": "806-355-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI-PARK PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "PANDOLFI",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER-PHARMACIST",
        "authorized_official_telephone_number": "806-359-5496",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "14575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143815",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4551669",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.