Vicquieron Kalrissian Abbott
Individual provider Active NPI Pharmacist · Port Arthur, TX
NPI 1124854823 · NPPES record last updated Apr 6, 2025
Key facts
- NPI
- 1124854823
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 74729 (TX)
- Practice address
- 3700 Highway 365
Port Arthur, TX 77642-7709 - Phone
- (409) 724-1914
- NPI assigned
- Sep 10, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74729 | TX | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 74729 | TX | Yes |
Addresses
Primary practice location
3700 Highway 365
Port Arthur, TX 77642-7709
Mailing address
3700 Highway 365
Port Arthur, TX 77642-7709
Other providers in Port Arthur, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.