NPIMap

Organization Active NPI

Pharm Nacogdoches Acquisition LLC

  • Community/Retail Pharmacy
  • Nacogdoches, TX
National Provider Identifier
1689109902
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
30632 Issued in TX
Legal business name
PHARM NACOGDOCHES ACQUISITION LLC
Practice address
212 North St Ste B
Nacogdoches, TX 75961-5260
Phone
(936) 462-9101
NPI assigned
Apr 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Authorized official

Name
Matthew Finn
Title
Officer
Phone
(469) 261-3048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 30632 TX Primary

Addresses

Primary practice location

212 North St Ste B
Nacogdoches, TX 75961-5260

Mailing address

212 North St Ste B
Nacogdoches, TX 75961-5260

Other identifiers 1

IdentifierTypeStateIssuer
14380MedicaidTX

Other names 1

  • THE MEDICINE SHOPPE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pharm Nacogdoches Acquisition LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624924800000",
    "number": "1689109902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 NORTH ST STE B",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759615260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 NORTH ST STE B",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759615260",
            "telephone_number": "936-462-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARM NACOGDOCHES ACQUISITION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-24",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A",
        "authorized_official_last_name": "FINN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "469-261-3048"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "30632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14380",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE MEDICINE SHOPPE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.