Pharmcare USA of Lubbock LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

31536 Issued in TX

Legal business name

PHARMCARE USA OF LUBBOCK LLC

Practice address

6102 45TH St
Suite C
Lubbock, TX 79407-3752

Phone

(866) 219-3619

Fax

(877) 505-7999

NPI assigned

Aug 28, 2017

Organization subpart

No

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

Authorized official

Name

Doris Gomersall

Title

VP of Compliance

Phone

(866) 219-3619

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Pharmcare USA of Lubbock Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1497272694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "HYDRO",
            "state": "OK",
            "postal_code": "730480365",
            "telephone_number": "866-219-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6102 45TH ST",
            "address_2": "SUITE C",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794073752",
            "telephone_number": "866-219-3619",
            "fax_number": "877-505-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMCARE USA OF LUBBOCK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "GOMERSALL",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "VP OF COMPLIANCE",
        "authorized_official_telephone_number": "866-219-3619"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TX",
            "license": "31536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351065",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2169520",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmcare USA of Lubbock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kyla Petrie, MD
• Trey Colin Petty, R.T.(R)
• Derek Pfeiffer, DPT
• Pforym Business Solutions, Inc
• Doanh K Phan, MD.PA.
• Pharmerica Drug Systems LLC
• PHCC-Windmill Village Rehabilitation & Health Care Center, LLC
• Katherine Nicole Phelan, LPC ASSOCIATE
• Kathleen Ann Phelan
• Dana Jill Phemister, RN MSN

• Long Term Care Pharmacy in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Long Term Care Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.