Active NPI
Michael Mouton
- Pharmacist
- San Augustine, TX
National Provider Identifier
1306433552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 65209
- Practice address
- 705 W Columbia St
San Augustine, TX 75972-1710 - Phone
- (936) 275-9060
- NPI assigned
- Dec 22, 2020
- Last updated
- Dec 22, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 65209 | TX | Primary |
Addresses
Primary practice location
705 W Columbia St
San Augustine, TX 75972-1710
Mailing address
705 W Columbia St
San Augustine, TX 75972-1710
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 |
|---|---|---|---|
| 65209 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brookshire Brothers Inc | Past | Accepting new patients | |
| Brookshire Brothers Inc | 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.
-
dba Brookshire Brothers Pharmacy
- Community/Retail Pharmacy
- San Augustine, TX
- NPI 1134228455
-
- Community/Retail Pharmacy
- Jarrell, TX
- NPI 1396615183
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608595200000",
"number": "1306433552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "705 W COLUMBIA ST",
"city": "SAN AUGUSTINE",
"state": "TX",
"postal_code": "759721710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 W COLUMBIA ST",
"city": "SAN AUGUSTINE",
"state": "TX",
"postal_code": "759721710",
"telephone_number": "936-275-9060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUTON",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-22",
"last_updated": "2020-12-22",
"certification_date": "2020-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "65209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Augustine, TX
- Memorial Hospital San Augustine
- Memorial Medical Center San Augustine (CHI St. Luke's Health Memorial San Augustine)
- Memorial Medical Center-San Augustine (San Augustine Rural Health Clinic)
- Memorial Medical Center-San Augustine (San Augustine Dialysis Clinic)
- Mariana Mendoza, FNP-C
- Jodee Naples, APRN, FNP-C
- John H Oglesbee III, M.D.
- Sara Oglesbee, MD
- Sharon Kay Oglesbee, RN-FNP
- Curtis Leon Pillow Jr., PTA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 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.