Doughertys Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

03246 Issued in TX

Legal business name

DOUGHERTYS PHARMACY INC

Practice address

12835 Preston Rd Ste 202
Dallas, TX 75230-1277

Phone

(214) 373-5300

Fax

(214) 739-0238

NPI assigned

Sep 2, 2005

Organization subpart

No

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

Authorized official

Name

Terry Dewitt

Title

Ceo

Phone

(254) 722-7912

Specialties & licenses 6

Addresses

Other identifiers 2

Other names 1

• Dougherty's Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Steven Rodriguez, PHARMD

  • Pharmacist
  • Dallas, TX
  • NPI 1851028120
  NPD

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636934400000",
    "number": "1124012315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12835 PRESTON RD STE 202",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752301277",
            "telephone_number": "214-373-5300",
            "fax_number": "214-739-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12835 PRESTON RD STE 202",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752301277",
            "telephone_number": "214-373-5300",
            "fax_number": "214-739-0238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGHERTYS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-02",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "DEWITT",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-722-7912"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "03246",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086333401",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2099454",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dougherty's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mitchell Reid Dougherty, DC
• Patrick Kelly Dougherty, MPAS, PA-C
• Dougherty'S Pharmacy Inc.
• Doughertys LTC Pharmacy LLC
• Doughertys Pharmacy Inc
• Doughertys Pharmacy Inc
• Kyle Edward Doughty, M.D.
• Douglas Avenue Medical Management Co
• Douglas Bellamy, Edd Psychologist PC
• Douglas R. Turgeon, M.D., P.a.

• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.