Active NPI
Dieudonne F Fomboh
- Pharmacist
- Palestine, TX
National Provider Identifier
1568896702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 53837
- Practice address
- 2201 S Loop 256
Palestine, TX 75801-4701 - Phone
- (903) 723-4705
- Fax
- (903) 723-4703
- NPI assigned
- Aug 23, 2013
- Last updated
- Aug 9, 2021
- 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 | 53837 | TX | Primary |
Addresses
Primary practice location
2201 S Loop 256
Palestine, TX 75801-4701
Mailing address
2201 S Loop 256
Palestine, TX 75801-4701
Phone (903) 723-4705
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53837 | TX | MD | Clinical Social Worker |
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": "1377216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628467200000",
"number": "1568896702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 S LOOP 256",
"city": "PALESTINE",
"state": "TX",
"postal_code": "758014701",
"telephone_number": "903-723-4705",
"fax_number": "903-723-4703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 S LOOP 256",
"city": "PALESTINE",
"state": "TX",
"postal_code": "758014701",
"telephone_number": "903-723-4705",
"fax_number": "903-723-4703"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMBOH",
"first_name": "DIEUDONNE",
"middle_name": "F",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-23",
"last_updated": "2021-08-09",
"certification_date": "2021-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "53837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palestine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.