Jason Ryan Pena

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

61340 Issued in TX

Practice address

1215 North St
Nacogdoches, TX 75961-4034

Phone

(936) 569-9884

NPI assigned

Oct 23, 2020

Last updated

Oct 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kroger Texas L P

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Nacogdoches, TX
  • NPI 1447323977
  NPD (past)
• Kroger Texas LP

  dba Kroger Pharmacy #541

  • Community/Retail Pharmacy
  • Fort Worth, TX
  • NPI 1407747439
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1669071270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 NORTH ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614034",
            "telephone_number": "936-569-9884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 NORTH ST",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614034",
            "telephone_number": "936-569-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "JASON",
        "middle_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TX",
            "license": "61340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prithvi Patel, MS CCC/SLP
• Brooke Alyssa Patterson
• Robert Baldwin Patterson
• Carolyn Louise Patton, RN MSN FNP
• Justin Pelham, MS RD LD
• Jobeth Perkins, MED., CCC/SLP
• Daniella E Perritt, COTA
• Casey Danielle Perry, AU.D.
• Hannah Ford Peterson, PHARM D
• Thu Pham

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Nacogdoches, TX
• Providers in Nacogdoches, TX by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; 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.