Organization Active NPI

MD Pharmacy

  • Community/Retail Pharmacy
  • Baytown, TX
National Provider Identifier
1649304189
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
25434 Issued in TX
Legal business name
MD PHARMACY
Practice address
11540 Eagle Dr
Ste a
Baytown, TX 77523-7653
Phone
(281) 576-0106
Fax
(281) 576-5511
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name
John DyerNPI 1396772927
Title
Onwer
Phone
(713) 829-4611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 25434 TX Primary

Addresses

Primary practice location

11540 Eagle Dr
Ste a
Baytown, TX 77523-7653

Mailing address

11540 Eagle Dr
Ste a
Baytown, TX 77523-7653
Phone (281) 576-0106

Other identifiers 2

IdentifierTypeStateIssuer
2100018OtherPK
145776MedicaidTX

Other names 1

  • MD PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090216000446 TX Part B Supplier - Mass Immunization (Roster Biller Only) 0941365589 Practice locations: Baytown, TX

National Provider Directory

National Provider Directory

Locations

11540 Eagle Dr
Ste A
Baytown, TX 77523
Phone (281) 576-0106

Practitioners & affiliated clinicians

Practitioners 1

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": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1649304189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11540 EAGLE DR",
            "address_2": "STE A",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775237653",
            "telephone_number": "281-576-0106",
            "fax_number": "281-576-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11540 EAGLE DR",
            "address_2": "STE A",
            "city": "BAYTOWN",
            "state": "TX",
            "postal_code": "775237653",
            "telephone_number": "281-576-0106",
            "fax_number": "281-576-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ONWER",
        "authorized_official_telephone_number": "713-829-4611"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "25434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2100018",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145776",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baytown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.