Active NPI
Abeldt Enterprises Inc
Doing business as Brickstreet Pharmacy
- Durable Medical Equipment & Medical Supplies
- Tyler, TX
National Provider Identifier
1659406734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 006419
- Legal business name
- ABELDT ENTERPRISES INC
- Doing business as
- Brickstreet Pharmacy
- Practice address
- 314 W Rusk St
Tyler, TX 75701-1513 - Phone
- (903) 533-8155
- Fax
- (903) 533-8158
- NPI assigned
- Feb 22, 2007
- Last updated
- Jun 12, 2024
- 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
- Jeffrey V Abeldt, RPH
- Title
- President/Owner
- Phone
- (903) 533-8155
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 006419 | TX | Primary |
| Community/Retail Pharmacy | 3336C0003X | 21015 | TX |
Addresses
Primary practice location
314 W Rusk St
Tyler, TX 75701-1513
Mailing address
314 W Rusk St
Tyler, TX 75701-1513
Phone (903) 533-8155
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145088 | Medicaid | TX | |
| 530989 | Other | TX | BCBSTX |
| 1455244801 | Medicaid | TX |
Other names 1
- BRICKSTREET 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 |
|---|---|---|---|---|
| O20100930028289 | TX | DME Supplier - Pharmacy | 1557465796 | Practice locations: Tyler, TX |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Brick Street Pharmacy
- Community/Retail Pharmacy
- Tyler, TX
- NPI 1407874936
1557465796
National Provider Directory
National Provider Directory- Tax ID family
- Abeldt Enterprises
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Abeldt Enterprises, Inc. DBA BrickStreet Pharmacy
- Long Term Care Pharmacy
- Tyler, TX
- NPI 1477598514
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
- Tyler, TX
- NPI 1407067911
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1718150400000",
"number": "1659406734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "314 W RUSK ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757011513",
"telephone_number": "903-533-8155",
"fax_number": "903-533-8158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 W RUSK ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757011513",
"telephone_number": "903-533-8155",
"fax_number": "903-533-8158"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ABELDT ENTERPRISES INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-22",
"last_updated": "2024-06-12",
"certification_date": "2024-06-12",
"status": "A",
"authorized_official_last_name": "ABELDT",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "V",
"authorized_official_title_or_position": "PRESIDENT/OWNER",
"authorized_official_telephone_number": "903-533-8155",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "TX",
"license": "006419",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "21015",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "145088",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSTX",
"identifier": "530989",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1455244801",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "BRICKSTREET PHARMACY",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "BRICKSTREET PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tyler, TX
- Abc Eyecare (Vision Source of Tyler)
- Amina Khalifa Abdallah, LVN
- Yousef Mahmoud Abdel-Raziq, MD
- Kristi Abel
- Abeldt Enterprises (Brick Street Pharmacy)
- Abeldt Enterprises, Inc. (Abeldt Enterprises, Inc. DBA BrickStreet Pharmacy)
- Jeffrey V Abeldt
- Jaclyn Nicole Abell, LPC, NCC
- Nikita Abernathy
- Stacy Delyn Abernathy, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.