Active NPI
Mary Grace Andrejko, PHARM.D.
- Pharmacist
- Westworth Village, TX
National Provider Identifier
1114528122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 41947
- Practice address
- 6760 Westworth Blvd
Westworth Village, TX 76114 - Phone
- (817) 763-9820
- Fax
- (817) 763-9832
- NPI assigned
- Nov 5, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 41947 | TX | Primary |
Addresses
Primary practice location
6760 Westworth Blvd
Westworth Village, TX 76114
Mailing address
5717 Starboardway Dr
Fort Worth, TX 76135-1828
Phone (817) 692-9168
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 |
|---|---|---|---|
| 41947 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714435200000",
"number": "1114528122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5717 STARBOARDWAY DR",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761351828",
"telephone_number": "817-692-9168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6760 WESTWORTH BLVD",
"city": "WESTWORTH VILLAGE",
"state": "TX",
"postal_code": "76114",
"telephone_number": "817-763-9820",
"fax_number": "817-763-9832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDREJKO",
"first_name": "MARY",
"middle_name": "GRACE",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-05",
"last_updated": "2024-04-30",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "41947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westworth Village, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.