Active NPI
Autumn Theresa Prestenback
- Pharmacist
- College Station, TX
National Provider Identifier
1427725514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 69087
- Practice address
- 1800 Rock Prairie Rd
College Station, TX 77845-5949 - Phone
- (979) 696-1075
- NPI assigned
- Aug 26, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 69087 | TX | Primary |
Addresses
Primary practice location
1800 Rock Prairie Rd
College Station, TX 77845-5949
Mailing address
3406 Judythe CT
Bryan, TX 77803-0481
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69087 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629936000000",
"number": "1427725514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3406 JUDYTHE CT",
"city": "BRYAN",
"state": "TX",
"postal_code": "778030481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 ROCK PRAIRIE RD",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778455949",
"telephone_number": "979-696-1075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRESTENBACK",
"first_name": "AUTUMN",
"middle_name": "THERESA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-26",
"last_updated": "2021-08-26",
"certification_date": "2021-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "69087",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.