Crimson Care Pharmacy Group I., LLC
Organization Active NPI Community/Retail Pharmacy · Whitney, TX
NPI 1104981216 · NPPES record last updated Jun 27, 2023
Key facts
- NPI
- 1104981216
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 12636 (TX)
- Legal business name
- CRIMSON CARE PHARMACY GROUP I., LLC
- Practice address
- 203 E Jefferson Ave
Whitney, TX 76692-2302 - Phone
- (254) 694-2249
- Fax
- (254) 694-6495
- NPI assigned
- Dec 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Willie Douglas, PHARM. D.
- Title
- Pharmacist / Owner
- Phone
- (254) 694-2249
Corporate family (same tax ID) 1
Practitioners 4
-
Willie Lee Douglas, PHARM D
-
Mary Acosta, PHARMD
-
Robyn Loraine Barnes, RPH
-
Stephen Dean Bennett, RPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160718002018 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 6002109717 | Practice locations: Whitney, TX |
National Provider Directory
- Tax ID family
- Crimson Care Pharmacy Group I LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 12636 | TX | Yes |
Addresses
Primary practice location
203 E Jefferson Ave
Whitney, TX 76692-2302
Mailing address
PO Box 1126
Whitney, TX 76692-1126
Phone (254) 694-2249
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 143231 | Medicaid | TX | |
| 19055070102 | Medicaid | TX | |
| 2096515 | Other | PK |
Other names
- PRESCRIPTION PHARMACY
Other providers in Whitney, TX
- Clayton Pickering DO, PA.
- Clifford N. Auten, D.D.S,
- Heather Faye Clinton
- Richard Edward Cofer Jr.
- Kandace Renae Collins
- Crimson Care Pharmacy Group I., LLC
- Willie Lee Douglas
- James D Drees
- Cade Yocham Erwin
- Eshna Inc.
All providers in Whitney, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.