Pharmacy Care USA of Addison, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

28672 Issued in TX

Legal business name

PHARMACY CARE USA OF ADDISON, LLC

Practice address

4500 Ratliff Lane
Suite 102
Addison, TX 75001

Phone

(972) 388-1800

Fax

(877) 505-7999

NPI assigned

Aug 14, 2013

Organization subpart

No

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

Authorized official

Name

Doris Petek-Gomersall

Title

SVP Corporate Compliance

Phone

(970) 250-2044

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Pharmacy Care USA of Addison, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Tax ID family

Pharmacy Care USA of Addison LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pharmacy Care USA of Addison, LLC

  • Community/Retail Pharmacy
  • Addison, TX
  • NPI 1689008377
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Stewart, PHARM.D.

  • Geriatric Pharmacist
  • Addison, TX
  • NPI 1326720343
  NPD (past)

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

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551312000000",
    "number": "1669805628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 365",
            "city": "HYDRO",
            "state": "OK",
            "postal_code": "73048",
            "telephone_number": "972-388-1800",
            "fax_number": "877-505-7999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 RATLIFF LANE",
            "address_2": "SUITE 102",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "75001",
            "telephone_number": "972-388-1800",
            "fax_number": "877-505-7999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACY CARE USA OF ADDISON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-14",
        "last_updated": "2019-02-28",
        "status": "A",
        "authorized_official_last_name": "PETEK-GOMERSALL",
        "authorized_official_first_name": "DORIS",
        "authorized_official_title_or_position": "SVP CORPORATE COMPLIANCE",
        "authorized_official_telephone_number": "970-250-2044"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TX",
            "license": "28672",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2141466",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmacy Care USA of Addison, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pharmacy Care USA of Addison, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laurie Ames Petty, M.ED., LPC, P.A.
• Annie Pham
• Cindy Quynhchi Phan, DDS
• Elizabeth T Phan, DPT
• Nichole Phan
• Pharmacy Care USA of Addison, LLC
• Dennis Phillips
• PHMT, LLC
• Phymed Neuromonitoring PLLC
• Melanie Rae Pickering, DO

• Long Term Care Pharmacy in Addison, TX
• Providers in Addison, TX by specialty
• Long Term Care Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2019; 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.

Verify at the official NPI Registry.