NPIMap

Organization Active NPI

Tackett Custom Medicine

  • Clinic/Center
  • Weatherford, TX
National Provider Identifier
1497009583
Registry record updated Oct 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
28226 Issued in TX
Legal business name
TACKETT CUSTOM MEDICINE
Practice address
175 College Park Dr
Weatherford, TX 76086-6211
Phone
(817) 550-6046
Fax
(817) 550-6047
NPI assigned
Oct 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2012

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

Authorized official

Name
Dr. David Roger Morris, PHARM.D.
Title
Pic
Phone
(817) 441-7046

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 28226 TX Primary

Addresses

Primary practice location

175 College Park Dr
Weatherford, TX 76086-6211

Mailing address

132 El Chico TRL
Willow Park, TX 76087-8865
Phone (817) 441-7046

National Provider Directory

National Provider Directory
Tax ID family
Tackett Pharmacy4 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.

NPI Registry JSON

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

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351468800000",
    "number": "1497009583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 EL CHICO TRL",
            "city": "WILLOW PARK",
            "state": "TX",
            "postal_code": "760878865",
            "telephone_number": "817-441-7046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 COLLEGE PARK DR",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760866211",
            "telephone_number": "817-550-6046",
            "fax_number": "817-550-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACKETT CUSTOM MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-29",
        "last_updated": "2012-10-29",
        "status": "A",
        "authorized_official_last_name": "MORRIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ROGER",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "817-441-7046",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TX",
            "license": "28226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Weatherford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2012; 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.