NPIMap

Organization Active NPI

Glenwood Pharmacy

  • Community/Retail Pharmacy
  • Texarkana, TX
National Provider Identifier
1689702334
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
19507 Issued in TX
Legal business name
GLENWOOD PHARMACY
Practice address
1400 College Dr
Texarkana, TX 75503-3534
Phone
(903) 792-8296
Fax
(903) 792-2261
NPI assigned
Mar 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Daniel Lukas
Title
Pharmacist
Phone
(903) 792-8296

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 19507 TX Primary

Addresses

Primary practice location

1400 College Dr
Texarkana, TX 75503-3534

Mailing address

1400 College Dr
Texarkana, TX 75503-3534
Phone (903) 792-8296

Other identifiers 2

IdentifierTypeStateIssuer
144971MedicaidTX
4503199OtherNCPDP

National Provider Directory

National Provider Directory
Tax ID family
Christus Health Ark-la-Tex7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689702334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 COLLEGE DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033534",
            "telephone_number": "903-792-8296",
            "fax_number": "903-792-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COLLEGE DR",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033534",
            "telephone_number": "903-792-8296",
            "fax_number": "903-792-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENWOOD PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUKAS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "903-792-8296",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "19507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144971",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4503199",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.