Active NPI
Davy Crockett Drug, Inc.
- Long Term Care Pharmacy
- Crockett, TX
National Provider Identifier
1649752163
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- License
- 04623
- Legal business name
- DAVY CROCKETT DRUG, INC.
- Practice address
- 107 S 4TH St
Crockett, TX 75835-2024 - Phone
- (936) 544-2275
- Fax
- (936) 206-7696
- NPI assigned
- Aug 31, 2018
- Last updated
- Sep 5, 2025
- 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
- James Jeffrey Martin, RPH
- Title
- President
- Phone
- (936) 544-2275
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 |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | 04623 | TX | Primary |
Addresses
Primary practice location
107 S 4TH St
Crockett, TX 75835-2024
Mailing address
107 S 4TH St
Crockett, TX 75835-2024
Phone (936) 544-2275
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 141598 | Medicaid | TX |
Other names 1
- Davy Crockett Drug (LTC)
National Provider Directory
National Provider DirectoryLocations
107 S 4th St
Crockett, TX 75835
Phone (936) 544-2275
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Crockett, TX
- NPI 1467013870
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535673600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1757030400000",
"number": "1649752163",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 S 4TH ST",
"city": "CROCKETT",
"state": "TX",
"postal_code": "758352024",
"telephone_number": "936-544-2275",
"fax_number": "936-206-7696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 S 4TH ST",
"city": "CROCKETT",
"state": "TX",
"postal_code": "758352024",
"telephone_number": "936-544-2275",
"fax_number": "936-206-7696"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DAVY CROCKETT DRUG, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2018-08-31",
"last_updated": "2025-09-05",
"certification_date": "2025-09-05",
"status": "A",
"authorized_official_last_name": "MARTIN",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "JEFFREY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "936-544-2275",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": "TX",
"license": "04623",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "141598",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Davy Crockett Drug (LTC)",
"code": "5",
"type": "Other Name"
},
{
"organization_name": "Davy Crockett Drug (LTC)",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Crockett, TX
- Davis Medical Transportation
- Gabrielle Nicole Davis
- Rosa Lee Davis, M.ED., LPC
- Shemira Davis, QMHP-CS
- Davy Crockett Drug, Inc.
- Carol S Dawson, LCSW
- DCD Equipment, Inc (Davy Crockett Drug Clinical Services)
- East Texas Medical Center (ETMC Crockett Family Medical Center RHC)
- East Texas Medical Center Crockett (ETMC Crockett)
- East Texas Medical Center Crockett
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.