Active NPI
Mary Jane Chang Kooijman, RPH
- Pharmacist
- Pearland, TX
National Provider Identifier
1528655586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 57254
- Practice address
- 11600 Shadow Creek Pkwy # 507120
Pearland, TX 77584-7261 - Phone
- (713) 436-8250
- NPI assigned
- Dec 24, 2020
- Last updated
- Dec 24, 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 | 57254 | TX | Primary |
Addresses
Primary practice location
11600 Shadow Creek Pkwy # 507120
Pearland, TX 77584-7261
Mailing address
11600 Shadow Creek Pkwy # 7120
Pearland, TX 77584-7261
Phone (713) 436-8250
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57254 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | 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": "1608768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608768000000",
"number": "1528655586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11600 SHADOW CREEK PKWY # 7120",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775847261",
"telephone_number": "713-436-8250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11600 SHADOW CREEK PKWY # 507120",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775847261",
"telephone_number": "713-436-8250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOOIJMAN",
"first_name": "MARY JANE",
"middle_name": "CHANG",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-24",
"last_updated": "2020-12-24",
"certification_date": "2020-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "57254",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.