NPIMap

Organization Active NPI

Crestview Pharmacy, LLC

  • Community/Retail Pharmacy
  • Austin, TX
National Provider Identifier
1184744344
Registry record updated Mar 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
27870 Issued in TX
Legal business name
CRESTVIEW PHARMACY, LLC
Practice address
7100 Woodrow Ave
Austin, TX 78757-1802
Phone
(512) 452-9535
Fax
(512) 452-9583
NPI assigned
Mar 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2012

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

Authorized official

Name
Mr. Jerry Dwayne Harper, RPH.
Title
Pharmacist
Phone
(512) 452-9535

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 27870 TX Primary

Addresses

Primary practice location

7100 Woodrow Ave
Austin, TX 78757-1802

Mailing address

7100 Woodrow Ave
Austin, TX 78757-1802
Phone (512) 452-9535

Other identifiers 1

IdentifierTypeStateIssuer
110134MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Crestview Pharmacy2 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.

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331596800000",
    "number": "1184744344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 WOODROW AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787571802",
            "telephone_number": "512-452-9535",
            "fax_number": "512-452-9583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 WOODROW AVE",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787571802",
            "telephone_number": "512-452-9535",
            "fax_number": "512-452-9583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2012-03-13",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "DWAYNE",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "512-452-9535",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110134",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; 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.