Active NPI
Sina Mahboubi, PHARMD
- Pharmacist
- College Station, TX
National Provider Identifier
1508273079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 52642
- Practice address
- 3535 Longmire Dr
College Station, TX 77845-5271 - Phone
- (979) 485-8813
- NPI assigned
- Jul 16, 2014
- Last updated
- Jul 16, 2014
- Sex
- Male
- 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 | 52642 | TX | Primary |
Addresses
Primary practice location
3535 Longmire Dr
College Station, TX 77845-5271
Mailing address
2250 Dartmouth St Apt 713
College Station, TX 77840-4693
Phone (614) 623-7052
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52642 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Texas LP | Past | Accepting new patients | |
| Kroger Texas L P | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1405468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405468800000",
"number": "1508273079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2250 DARTMOUTH ST APT 713",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778404693",
"telephone_number": "614-623-7052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 LONGMIRE DR",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778455271",
"telephone_number": "979-485-8813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHBOUBI",
"first_name": "SINA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-16",
"last_updated": "2014-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "52642",
"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 Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.