Christian Lyle Andrew Mactavish

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

310666 Issued in TX

Practice address

701 W Parkwood Ave
Friendswood, TX 77546-5405

Phone

(281) 996-9971

Fax

(281) 996-9980

NPI assigned

Apr 14, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618358400000",
    "number": "1205417037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 W PARKWOOD AVE",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775465405",
            "telephone_number": "281-996-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 W PARKWOOD AVE",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775465405",
            "telephone_number": "281-996-9971",
            "fax_number": "281-996-9980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACTAVISH",
        "first_name": "CHRISTIAN",
        "middle_name": "LYLE ANDREW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-14",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "310666",
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacy Technician",
            "state": "TX",
            "license": "310666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica of America Inc.
• Luxury Wellness Providers
• James Donald Lyle, LCSW
• Kit Ying Ma, LMSW
• Lauryn Rose Mack
• Made Ya Smile Friendswood PLLC
• Alicia Marie Madeksho, LPC
• Kassandra Madrid, RBT
• Victor Hugo Magallanes
• Natasha Mahesh

• Pharmacy Technician in Friendswood, TX
• Providers in Friendswood, TX by specialty
• Pharmacy Technician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.

Verify at the official NPI Registry.