Pharm Nacogdoches Acquisition LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PHARM NACOGDOCHES ACQUISITION LLC

Practice address

212 North St
Ste B
Nacogdoches, TX 75961

Phone

(817) 442-0484

Fax

(817) 977-5086

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Matthew Finn

Title

Officer

Phone

(817) 442-0484

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• The Medicine Shoppe Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Pharm Nacogdoches Acquisition LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Pharm Nacogdoches Acquisition LLC

  • Long Term Care Pharmacy
  • Nacogdoches, TX
  • NPI 1013694264
  NPD tax ID
• Pharm Nacogdoches Acquisition LLC

  • Community/Retail Pharmacy
  • Nacogdoches, TX
  • NPI 1689109902
  NPD tax ID

Locations

Practitioners 1

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

• Waseem Haddad, RPH

  • Pharmacist
  • Nacogdoches, TX
  • NPI 1801499595
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1124172572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 NORTH ST",
            "address_2": "STE B",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75961",
            "telephone_number": "936-569-6430",
            "fax_number": "817-977-5086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 NORTH ST",
            "address_2": "STE B",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "75961",
            "telephone_number": "817-442-0484",
            "fax_number": "817-977-5086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARM NACOGDOCHES ACQUISITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2023-03-07",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "FINN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "817-442-0484"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "12958",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275719",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143380",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4577613",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Medicine Shoppe",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Medicine Shoppe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniella E Perritt, COTA
• Casey Danielle Perry, AU.D.
• Hannah Ford Peterson, PHARM D
• Thu Pham
• Pharm Nacogdoches Acquisition LLC
• Pharm Nacogdoches Acquisition LLC
• Mark David Picou, PT
• Lacee G Pierce, NP
• Jacqueline La-Shawn Pierre, OD
• Pine View Counseling and Consulting PLLC

• Community/Retail Pharmacy in Nacogdoches, TX
• Providers in Nacogdoches, 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 Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.