Jeremiah Michael Light

Primary specialty

PharmacistTaxonomy code 183500000X

License

58587 Issued in TX

Practice address

10781 Toepperwein Rd
Converse, TX 78109-2561

Phone

(210) 672-6812

NPI assigned

Nov 27, 2020

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wal-Mart Stores Texas LLC

  • Community/Retail Pharmacy
  • Converse, TX
  • NPI 1245688449
  NPD (past)
• Wal-Mart Stores Texas, LLC

  • Community/Retail Pharmacy
  • Melissa, TX
  • NPI 1386521797
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 27, 2020.

{
    "created_epoch": "1606435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606435200000",
    "number": "1366046617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3227 HOWARD ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782122363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10781 TOEPPERWEIN RD",
            "city": "CONVERSE",
            "state": "TX",
            "postal_code": "781092561",
            "telephone_number": "210-672-6812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "JEREMIAH",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-27",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "58587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reginald Lawson, LPC, LMFT
• Jane Lee, DMD
• Bianca N Lenzy, NNP
• Rissah Sharon Lewis
• Sarah Elizabeth Liberty, BCBA, LBA, MA
• Jacqueline Segura Loden, LPC
• Lonestar Braces PLLC
• Catherine Rose Barrios Lopez, PHYSICAL THERAPIST
• Tiffany Lopez, ACNPC-AG
• Lauren Marie Lozano, LMT

• All providers in Converse, TX
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.

Verify at the official NPI Registry.