Organization Active NPI

Davy Crockett Drug, Inc.

  • Long Term Care Pharmacy
  • Crockett, TX
National Provider Identifier
1649752163
Registry record updated Sep 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
04623 Issued in TX
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, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2025

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

Authorized official

Name
James Jeffrey Martin, RPHNPI 1467013870
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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
141598MedicaidTX

Other names 1

  • Davy Crockett Drug (LTC) Other name

National Provider Directory

National Provider Directory

Locations

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.

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

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.

Verify at the official NPI Registry.