Walters Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

05941 Issued in TX

Legal business name

WALTERS PHARMACY INC

Practice address

250 W Palm St
Bellville, TX 77418-1361

Phone

(979) 865-3696

Fax

(979) 865-3697

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

Michael Koehn, RPHNPI 1518558881

Title

Pic

Phone

(979) 865-3696

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Walter's Pharmacy, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

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

• Michael Koehn, R.PH.

  • Pharmacist
  • Bellville, TX
  • NPI 1518558881
  NPD Authorized official
• Jill Carley, RPH

  • Ambulatory Care Pharmacist
  • Bellville, TX
  • NPI 1740871359
  NPD
• Alma Jean Quintero, R. PH.

  • Pharmacist
  • Bellville, TX
  • NPI 1740004928
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1124176136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W PALM ST",
            "city": "BELLVILLE",
            "state": "TX",
            "postal_code": "774181361",
            "telephone_number": "979-865-3696",
            "fax_number": "979-865-3697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W PALM ST",
            "city": "BELLVILLE",
            "state": "TX",
            "postal_code": "774181361",
            "telephone_number": "979-865-3696",
            "fax_number": "979-865-3697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTERS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "KOEHN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "979-865-3696",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "05941",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2099889",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142084",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walter's Pharmacy, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Trish Surovik, LCDC, LPC-INTERN
• James Taylor Tidwell, DDS
• Tippit Dental Group Bellville PLLC
• Unistar Healthcare Services LLC
• Amanda Paula Walker, PHARM.D.
• Tarshya Wickramasinghe Warner, DDS
• Mary Elizabeth Washington
• Amelia Rae Williams, P.A.-C
• Sara Gayle Williams, PTA
• Ronald William Zboril, DDS

• All providers in Bellville, TX
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; 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.