Active NPI
J & L Pharmacy, Inc
- Customized Equipment (DME)
- Bryan, TX
National Provider Identifier
1427073790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Customized Equipment (DME)
- License
- 12500
- Legal business name
- J & L PHARMACY, INC
- Doing business as
- Medical Center Pharmacy, Medical Center Pharmacy Vital Care
- Practice address
- 200 W 26TH St
Bryan, TX 77803-3232 - Phone
- (979) 822-3575
- Fax
- (979) 823-7278
- NPI assigned
- Jul 13, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randy Mutz
- Title
- President
- Phone
- (979) 822-3575
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 12500 | TX | |
| Customized Equipment (DME) | 332BC3200X | 12500 | TX | Primary |
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | 12500 | TX | |
| Oxygen Equipment & Supplies (DME) | 332BX2000X | 12500 | TX | |
| Pharmacy | 333600000X | 12500 | TX | |
| Community/Retail Pharmacy | 3336C0003X | 12500 | TX | |
| Home Infusion Therapy Pharmacy | 3336H0001X | 12500 | TX | |
| Long Term Care Pharmacy | 3336L0003X | 12500 | TX | |
| Mail Order Pharmacy | 3336M0002X | 12500 | TX | |
| Specialty Pharmacy | 3336S0011X | 12500 | TX |
Addresses
Primary practice location
200 W 26TH St
Bryan, TX 77803-3232
Mailing address
PO Box 5047
Meridian, MS 39302-5047
Phone (800) 447-4095
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013833101 | Medicaid | TX | |
| 750655 | Other | TX | BCBS HIT |
| 1209983-04 | Medicaid | TX | |
| 519933 | Other | TX | BCBS DME |
| 104686100 | Other | FIRSTCARE | |
| 722475922-0001 | Other | CHAMPUS | |
| 1209983-02 | Medicaid | TX |
Other names 1
- Medical Center Pharmacy, Medical Center Pharmacy Vital Care
National Provider Directory
National Provider DirectoryLocations
200 W 26th St
Bryan, TX 77803
Phone (979) 822-3575
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1226534400000",
"number": "1427073790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5047",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393025047",
"telephone_number": "800-447-4095",
"fax_number": "601-482-7490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 W 26TH ST",
"city": "BRYAN",
"state": "TX",
"postal_code": "778033232",
"telephone_number": "979-822-3575",
"fax_number": "979-823-7278"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "J & L PHARMACY, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-13",
"last_updated": "2008-11-13",
"status": "A",
"authorized_official_last_name": "MUTZ",
"authorized_official_first_name": "RANDY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "979-822-3575"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "332BC3200X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
"state": "TX",
"license": "12500",
"primary": true
},
{
"code": "332BP3500X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "332BX2000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "3336H0001X",
"taxonomy_group": "",
"desc": "Pharmacy, Home Infusion Therapy Pharmacy",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "3336M0002X",
"taxonomy_group": "",
"desc": "Pharmacy, Mail Order Pharmacy",
"state": "TX",
"license": "12500",
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": "TX",
"license": "12500",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "013833101",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS HIT",
"identifier": "750655",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1209983-04",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS DME",
"identifier": "519933",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRSTCARE",
"identifier": "104686100",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "722475922-0001",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1209983-02",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Medical Center Pharmacy, Medical Center Pharmacy Vital Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bryan, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.