NPIMap

Organization Active NPI

Corporate Health Dimensions Dba Goodyear Pharmacy Tyler

  • Pharmacist
  • Tyler, TX
National Provider Identifier
1477606325
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
15096 Issued in TX
Legal business name
CORPORATE HEALTH DIMENSIONS DBA GOODYEAR PHARMACY TYLER
Practice address
13221 FM 206 Hwy 31 W
Tyler, TX 75709
Phone
(903) 592-3487
Fax
(903) 593-8737
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Delana D Staten, RPH
Title
Pharmacy Manager
Phone
(903) 592-3487

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 15096 TX Primary

Addresses

Primary practice location

13221 FM 206 Hwy 31 W
Tyler, TX 75709

Mailing address

P. O. Box 5450
Tyler, TX 75712
Phone (903) 592-3487

National Provider Directory

National Provider Directory
Tax ID family
Aetna Wellness Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477606325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 5450",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75712",
            "telephone_number": "903-592-3487",
            "fax_number": "903-593-8737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13221 FM 206 HWY 31 W",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75709",
            "telephone_number": "903-592-3487",
            "fax_number": "903-593-8737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORPORATE HEALTH DIMENSIONS DBA GOODYEAR PHARMACY TYLER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STATEN",
        "authorized_official_first_name": "DELANA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "903-592-3487",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "15096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 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.