Individual provider Active NPI

Mariz Abigail Buslon Abucejo, PHARMD, RPH

  • Pharmacist
  • Dallas, TX
National Provider Identifier
1639773229
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
65623 Issued in TX
Practice address
600 N Pearl St Ste H201
Dallas, TX 75201-7407
Phone
(214) 855-0606
NPI assigned
Nov 24, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 65623 TX Primary

Addresses

Primary practice location

600 N Pearl St Ste H201
Dallas, TX 75201-7407

Mailing address

3440 S Bryant Blvd
San Angelo, TX 76903-9308

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, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
65623TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Plaza Apothecary PLLC PastSince Sep 1, 2024 Accepting new patients
Legacy Apothecary LP PastSince May 29, 2022 Accepting new patients
Plaza Apothecary PLLC PastSince Sep 1, 2024 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1606176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724976000000",
    "number": "1639773229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 S BRYANT BLVD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769039308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N PEARL ST STE H201",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752017407",
            "telephone_number": "214-855-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABUCEJO",
        "first_name": "MARIZ ABIGAIL",
        "middle_name": "BUSLON",
        "credential": "PHARMD, RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-24",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "65623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2024; 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.