NPIMap

Organization Active NPI

Tackett Pharmacy

  • Community/Retail Pharmacy
  • Willow Park, TX
National Provider Identifier
1215022975
Registry record updated Jul 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
06761 Issued in TX
Legal business name
TACKETT PHARMACY
Practice address
132 El Chico TRL
Willow Park, TX 76087-8865
Phone
(817) 441-7046
Fax
(817) 441-5731
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2008

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

Authorized official

Name
Mark Andrew Tackett, PHARMACIST
Title
Owner Pharmacist in Charge
Phone
(817) 694-7360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 06761 TX Primary

Addresses

Primary practice location

132 El Chico TRL
Willow Park, TX 76087-8865

Mailing address

132 El Chico TRL
Willow Park, TX 76087-8865
Phone (817) 441-7046

Other identifiers 1

IdentifierTypeStateIssuer
142289MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Tackett Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216598400000",
    "number": "1215022975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 EL CHICO TRL",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760878865",
            "telephone_number": "817-441-7046",
            "fax_number": "817-441-5731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 EL CHICO TRL",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760878865",
            "telephone_number": "817-441-7046",
            "fax_number": "817-441-5731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACKETT PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2008-07-21",
        "status": "A",
        "authorized_official_last_name": "TACKETT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "817-694-7360",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "06761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142289",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willow Park, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2008; 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.