Active NPI
MD Pharmacy
- Community/Retail Pharmacy
- Baytown, TX
National Provider Identifier
1649304189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 25434
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John Dyer
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2100018 | Other | PK | |
| 145776 | Medicaid | TX |
Other names 1
- MD PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090216000446 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 0941365589 | Practice locations: Baytown, TX |
National Provider Directory
National Provider DirectoryLocations
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.
-
- Pharmacist
- Baytown, TX
- NPI 1396772927
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.