NPIMap

Organization Active NPI

Family Pharmacy of Pottsboro

  • Community/Retail Pharmacy
  • Pottsboro, TX
National Provider Identifier
1578659314
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
11831 Issued in TX
Legal business name
FAMILY PHARMACY OF POTTSBORO
Practice address
111 Hiway 120E
Suite 101
Pottsboro, TX 75076-0000
Phone
(903) 786-2006
Fax
(903) 786-4542
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Monty L. Washburn
Title
Owner
Phone
(903) 786-2006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 11831 TX Primary

Addresses

Primary practice location

111 Hiway 120E
Suite 101
Pottsboro, TX 75076-0000

Mailing address

111 Hiway 120E
Suite 101
Pottsboro, TX 75076-0000
Phone (903) 786-2006

Other identifiers 2

IdentifierTypeStateIssuer
4572726OtherNCPDP NUMBER
143175MedicaidTX

National Provider Directory

National Provider Directory

Locations

111 E Highway 120
Ste 101
Pottsboro, TX 75076
Phone (903) 786-2006

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578659314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HIWAY 120E",
            "address_2": "SUITE 101",
            "city": "POTTSBORO",
            "state": "TX",
            "postal_code": "750760000",
            "telephone_number": "903-786-2006",
            "fax_number": "903-786-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 HIWAY 120E",
            "address_2": "SUITE 101",
            "city": "POTTSBORO",
            "state": "TX",
            "postal_code": "750760000",
            "telephone_number": "903-786-2006",
            "fax_number": "903-786-4542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PHARMACY OF POTTSBORO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WASHBURN",
        "authorized_official_first_name": "MONTY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-786-2006",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "11831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "4572726",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143175",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsboro, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.