NPIMap

Organization Active NPI

I.D. Doctors Pharmacy

  • Clinic Pharmacy
  • Bedford, TX
National Provider Identifier
1245579143
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
21765 Issued in TX
Legal business name
I.D. DOCTORS PHARMACY
Doing business as
I.D. Doctors Pharmacy
Practice address
2636 Tibbets Dr
Bedford, TX 76022-6919
Phone
(817) 858-0065
NPI assigned
Feb 12, 2013
Last updated
Apr 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Authorized official

Name
Heewon Suh
Title
Pharmacist
Phone
(972) 484-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 21765 TX Primary

Addresses

Primary practice location

2636 Tibbets Dr
Bedford, TX 76022-6919

Mailing address

2636 Tibbets Dr
Bedford, TX 76022-6919
Phone (972) 484-7700

Other identifiers 2

IdentifierTypeStateIssuer
5908011OtherNCPDP PROVIDER IDENTIFICATION NUMBER
146907401MedicaidTX

Other names 1

  • I.D. Doctors Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Id Doctors 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.

Locations

2636 Tibbets Dr
Bedford, TX 76022
Phone (817) 858-0065

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1360627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1245579143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2636 TIBBETS DR",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760226919",
            "telephone_number": "972-484-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2636 TIBBETS DR",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760226919",
            "telephone_number": "817-858-0065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I.D. DOCTORS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-12",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A",
        "authorized_official_last_name": "SUH",
        "authorized_official_first_name": "HEEWON",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "972-484-7700"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "TX",
            "license": "21765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5908011",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146907401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "I.D. Doctors Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "I.D. Doctors Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bedford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; 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.