Active NPI
Shundra Mack
- Pharmacist
- Longview, TX
National Provider Identifier
1619560372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 64902
- Practice address
- 3301 4TH St
Longview, TX 75605-7959 - Phone
- (903) 663-4362
- NPI assigned
- Feb 13, 2021
- Last updated
- Feb 13, 2021
- 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 | 64902 | TX | Primary |
Addresses
Primary practice location
3301 4TH St
Longview, TX 75605-7959
Mailing address
211 County Road 2781
Carthage, TX 75633-6194
Phone (903) 754-1623
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 |
|---|---|---|---|
| 64902 | TX | MD | Pharmacist |
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": "1613174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613174400000",
"number": "1619560372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 COUNTY ROAD 2781",
"city": "CARTHAGE",
"state": "TX",
"postal_code": "756336194",
"telephone_number": "903-754-1623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3301 4TH ST",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756057959",
"telephone_number": "903-663-4362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACK",
"first_name": "SHUNDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-13",
"last_updated": "2021-02-13",
"certification_date": "2021-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "64902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.