Active NPI
Mary Jo Ann Bro
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Bedford, TX
National Provider Identifier
1245860014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 31706
- Practice address
- 2109 Harwood Rd
Bedford, TX 76021-4705 - Phone
- (817) 685-9628
- Fax
- (817) 685-9349
- NPI assigned
- Jan 21, 2020
- Last updated
- Jan 21, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 16305 | IA | |
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 31706 | TX | Primary |
Addresses
Primary practice location
2109 Harwood Rd
Bedford, TX 76021-4705
Mailing address
2109 Harwood Rd
Bedford, TX 76021-4705
Phone (817) 685-9628
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 |
|---|---|---|---|
| 31706 | TX | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 16305 | IA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Texas L P | Past | Accepting new patients | |
| Kroger Texas LP | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579564800000",
"number": "1245860014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2109 HARWOOD RD",
"city": "BEDFORD",
"state": "TX",
"postal_code": "760214705",
"telephone_number": "817-685-9628",
"fax_number": "817-685-9349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2109 HARWOOD RD",
"city": "BEDFORD",
"state": "TX",
"postal_code": "760214705",
"telephone_number": "817-685-9628",
"fax_number": "817-685-9349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRO",
"first_name": "MARY",
"middle_name": "JO ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-21",
"last_updated": "2020-01-21",
"certification_date": "2020-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "IA",
"license": "16305",
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "TX",
"license": "31706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jan 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.