Active NPI
Manyo Ayuk-Tabe
- Pharmacist
- San Antonio, TX
National Provider Identifier
1154913564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 63790
- Practice address
- 3502 SE Military Dr
San Antonio, TX 78223-3486 - Phone
- (219) 359-0139
- NPI assigned
- Feb 7, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 63790 | TX | Primary |
Addresses
Primary practice location
3502 SE Military Dr
San Antonio, TX 78223-3486
Mailing address
3502 SE Military Dr
San Antonio, TX 78223-3486
Phone (219) 359-0139
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63790 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612656000000",
"number": "1154913564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3502 SE MILITARY DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782233486",
"telephone_number": "219-359-0139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3502 SE MILITARY DR",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782233486",
"telephone_number": "219-359-0139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AYUK-TABE",
"first_name": "MANYO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-02-07",
"last_updated": "2021-02-07",
"certification_date": "2021-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "63790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.