NPIMap

Organization Active NPI

Abeldt Enterprises

Doing business as Brick Street Pharmacy

  • Community/Retail Pharmacy
  • Tyler, TX
National Provider Identifier
1407874936
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
21015 Issued in TX
Legal business name
ABELDT ENTERPRISES
Doing business as
Brick Street Pharmacy
Practice address
314 W Rusk St
Tyler, TX 75701-1513
Phone
(903) 533-8155
Fax
(903) 533-8158
NPI assigned
Jul 17, 2006
Last updated
Jun 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Authorized official

Name
Jeffrey Abeldt, RPHNPI 1407067911
Title
Owner
Phone
(903) 533-8155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X 21015 TX Primary

Addresses

Primary practice location

314 W Rusk St
Tyler, TX 75701-1513

Mailing address

314 W Rusk St
Tyler, TX 75701-1513
Phone (903) 533-8155

Other identifiers 2

IdentifierTypeStateIssuer
145088MedicaidTX
2104357OtherPK

Other names 1

  • BRICK STREET PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070328000602 TX Part B Supplier - Pharmacy 1557465796 Practice locations: Tyler, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Abeldt Enterprises3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1407874936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 W RUSK ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011513",
            "telephone_number": "903-533-8155",
            "fax_number": "903-533-8158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 W RUSK ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011513",
            "telephone_number": "903-533-8155",
            "fax_number": "903-533-8158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABELDT ENTERPRISES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "ABELDT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-533-8155",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "21015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145088",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2104357",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRICK STREET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BRICK STREET PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.