Brackettville Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BRACKETTVILLE PHARMACY, LLC

Doing business as

Main Drug Company

Practice address

201 N Nixon Ave
Nixon, TX 78140-2723

Phone

(830) 582-1851

Fax

(830) 582-1357

NPI assigned

Dec 26, 2006

Last updated

Aug 19, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Yankton S Wyatt

Title

Owner

Phone

(830) 563-9334

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Main Drug Company Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Brackettville Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Brackettville Pharmacy, LLC

  dba Clinic Pharmacy

  • Community/Retail Pharmacy
  • Brackettville, TX
  • NPI 1912984626
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ernest Stirl

  • Pharmacist
  • Nixon, TX
  • NPI 1811530389
  NPD (past)
• Jonathan Frank Villarreal

  • Pharmacist
  • Nixon, TX
  • NPI 1477426500
  NPD (past)

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629331200000",
    "number": "1154486587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 HOSPITAL DR",
            "city": "ANDREWS",
            "state": "TX",
            "postal_code": "797143618",
            "telephone_number": "432-523-4861",
            "fax_number": "432-524-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N NIXON AVE",
            "city": "NIXON",
            "state": "TX",
            "postal_code": "781402723",
            "telephone_number": "830-582-1851",
            "fax_number": "830-582-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRACKETTVILLE PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "YANKTON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-563-9334"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149239",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2098543",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Drug Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amm PLLC (Nixon Family Dentistry)
• Dewitt Medical District (Nixon Family Practice)
• Gracia Medical, LLP (Nixon Family Practice and Obstetrics)
• Nixon Residential Care
• Nixon Smiley Isd
• Lisa Skelton Nixon

• Community/Retail Pharmacy in Nixon, TX
• Providers in Nixon, 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 Aug 19, 2021; 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.