Active NPI
Patti Black
- Pharmacist
- Gonzales, TX
National Provider Identifier
1487250510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 024119
- Practice address
- 1114 E Sarah Dewitt Dr
Gonzales, TX 78629 - Phone
- (830) 672-2811
- Fax
- (830) 672-6544
- NPI assigned
- Dec 4, 2020
- Last updated
- Dec 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 024119 | TX | Primary |
Addresses
Primary practice location
1114 E Sarah Dewitt Dr
Gonzales, TX 78629
Mailing address
429 Connolly Cir W
Lockhart, TX 78644-2943
Phone (512) 376-8035
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 |
|---|---|---|---|
| 024119 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607040000000",
"number": "1487250510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "429 CONNOLLY CIR W",
"city": "LOCKHART",
"state": "TX",
"postal_code": "786442943",
"telephone_number": "512-376-8035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1114 E SARAH DEWITT DR",
"city": "GONZALES",
"state": "TX",
"postal_code": "78629",
"telephone_number": "830-672-2811",
"fax_number": "830-672-6544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "PATTI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-04",
"last_updated": "2020-12-04",
"certification_date": "2020-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "024119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.