NPIMap

Organization Active NPI

Pharmblue Texas LLC

  • Community/Retail Pharmacy
  • Beaumont, TX
National Provider Identifier
1154799336
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
31190 Issued in TX
Legal business name
PHARMBLUE TEXAS LLC
Doing business as
PharmBlue Texas LLC
Practice address
1495 N 7TH St
Beaumont, TX 77702-1345
Phone
(800) 967-5020
Fax
(844) 873-8760
NPI assigned
Sep 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

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

Authorized official

Name
Michael Nelson
Title
Owner,Ceo, Ao
Phone
(724) 779-4720

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 31190 TX Primary
Long Term Care Pharmacy 3336L0003X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

1495 N 7TH St
Beaumont, TX 77702-1345

Mailing address

P. O. Box677949
Dallas, TX 75267-7949
Phone (724) 779-4720

Other identifiers 2

IdentifierTypeStateIssuer
2160901OtherPK
1154799336MedicaidTX

Other names 1

  • PharmBlue Texas LLC Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1495 N 7th St
Ste B
Beaumont, TX 77702
Phone (800) 967-5020

NPI Registry JSON

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

{
    "created_epoch": "1441324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1154799336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX677949",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752677949",
            "telephone_number": "724-779-4720",
            "fax_number": "724-779-4721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 N 7TH ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777021345",
            "telephone_number": "800-967-5020",
            "fax_number": "844-873-8760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMBLUE TEXAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-04",
        "last_updated": "2017-03-23",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER,CEO, AO",
        "authorized_official_telephone_number": "724-779-4720"
    },
    "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": "31190",
            "primary": true
        },
        {
            "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160901",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154799336",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PharmBlue Texas LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.