Active NPI
Matthew Lyle Pulley-Jennings, PHARMD
- Pharmacist
- College Station, TX
National Provider Identifier
1548996986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 70755
- Practice address
- 2322 Texas Ave S
College Station, TX 77840-4632 - Phone
- (979) 696-5908
- NPI assigned
- Jul 27, 2022
- Last updated
- Jul 27, 2022
- 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 | 70755 | TX | Primary |
Addresses
Primary practice location
2322 Texas Ave S
College Station, TX 77840-4632
Mailing address
1222 N Ridgefield Cir
College Station, TX 77840-4339
Phone (512) 573-2299
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 |
|---|---|---|---|
| 70755 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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": "1658880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658880000000",
"number": "1548996986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1222 N RIDGEFIELD CIR",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778404339",
"telephone_number": "512-573-2299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2322 TEXAS AVE S",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778404632",
"telephone_number": "979-696-5908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PULLEY-JENNINGS",
"first_name": "MATTHEW",
"middle_name": "LYLE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-27",
"last_updated": "2022-07-27",
"certification_date": "2022-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "70755",
"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 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.