NPIMap

Organization Active NPI

City Drug Jefferson Texas Inc

  • Community/Retail Pharmacy
  • Jefferson, TX
National Provider Identifier
1386699130
Registry record updated Oct 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
00141 Issued in TX
Legal business name
CITY DRUG JEFFERSON TEXAS INC
Practice address
109 W Lafayette St
Jefferson, TX 75657-2205
Phone
(903) 665-2521
Fax
(903) 665-7422
NPI assigned
May 23, 2006
Last updated
Oct 8, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2019

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

Authorized official

Name
Brian Allen Bates, RPHNPI 1598351249
Title
President
Phone
(903) 665-2521

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 00141 TX Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

109 W Lafayette St
Jefferson, TX 75657-2205

Mailing address

PO Box 856
Jefferson, TX 75657-0856
Phone (903) 665-2521

Other identifiers 2

IdentifierTypeStateIssuer
120423MedicaidTX
17946601MedicaidTX

National Provider Directory

National Provider Directory

Locations

109 W Lafayette St
Jefferson, TX 75657
Phone (903) 665-2521

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570492800000",
    "number": "1386699130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 856",
            "city": "JEFFERSON",
            "state": "TX",
            "postal_code": "756570856",
            "telephone_number": "903-665-2521",
            "fax_number": "903-665-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W LAFAYETTE ST",
            "city": "JEFFERSON",
            "state": "TX",
            "postal_code": "756572205",
            "telephone_number": "903-665-2521",
            "fax_number": "903-665-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY DRUG JEFFERSON TEXAS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2019-10-08",
        "status": "A",
        "authorized_official_last_name": "BATES",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-665-2521",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "00141",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120423",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17946601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2019; 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.