Active NPI
Marymagdalene Eyongegbe, PHARMD
- Pharmacist
- Grand Prairie, TX
National Provider Identifier
1508628835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 68542
- Practice address
- 810 W Pioneer Pkwy
Grand Prairie, TX 75051-4708 - Phone
- (972) 641-5744
- Fax
- (972) 641-0204
- NPI assigned
- Jan 23, 2024
- Sex
- Female
- 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 | 68542 | TX | Primary |
Addresses
Primary practice location
810 W Pioneer Pkwy
Grand Prairie, TX 75051-4708
Mailing address
16029 Charing Cross Dr
Justin, TX 76247-1761
Phone (832) 453-3117
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 |
|---|---|---|---|
| 68542 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705968000000",
"number": "1508628835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16029 CHARING CROSS DR",
"city": "JUSTIN",
"state": "TX",
"postal_code": "762471761",
"telephone_number": "832-453-3117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "810 W PIONEER PKWY",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750514708",
"telephone_number": "972-641-5744",
"fax_number": "972-641-0204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EYONGEGBE",
"first_name": "MARYMAGDALENE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-23",
"last_updated": "2024-01-23",
"certification_date": "2024-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "68542",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Prairie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.