Michael Mouton
Individual provider Active NPI Pharmacist · San Augustine, TX
NPI 1306433552 · NPPES record last updated Dec 22, 2020
Key facts
- NPI
- 1306433552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 65209 (TX)
- Practice address
- 705 W Columbia St
San Augustine, TX 75972-1710 - Phone
- (936) 275-9060
- NPI assigned
- Dec 22, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65209 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brookshire Brothers Inc | Past |
Accepting new patients | |
| Brookshire Brothers Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 65209 | TX | Yes |
Addresses
Primary practice location
705 W Columbia St
San Augustine, TX 75972-1710
Mailing address
705 W Columbia St
San Augustine, TX 75972-1710
Other providers in San Augustine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.