Archie Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

29936 Issued in TX

Legal business name

ARCHIE PHARMACY LLC

Doing business as

FP Specialty Pharmacy

Practice address

305 S Archie St
Vidor, TX 77662-4840

Phone

(409) 242-3124

Fax

(888) 870-3156

NPI assigned

May 21, 2015

Last updated

Sep 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Trey Haney

Title

Operations Manager

Phone

(409) 769-2406

Specialties & licenses 5

Addresses

Other names 1

• FP Specialty Pharmacy Doing business as

Locations

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631145600000",
    "number": "1275912453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 S ARCHIE ST",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776624840",
            "telephone_number": "409-242-3124",
            "fax_number": "888-870-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S ARCHIE ST",
            "city": "VIDOR",
            "state": "TX",
            "postal_code": "776624840",
            "telephone_number": "409-242-3124",
            "fax_number": "888-870-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCHIE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-21",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "HANEY",
        "authorized_official_first_name": "TREY",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "409-769-2406"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "29936",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FP Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jessica Miller Baker, NP
• Shannon Baldwin, COTA/L

• Community/Retail Pharmacy in Vidor, TX
• Providers in Vidor, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 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.