Active NPI
Grevelyn Kristine Mantohac
- Pharmacist
- Brownsville, TX
National Provider Identifier
1699329540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 63390
- Practice address
- 4490 E 14TH St
Brownsville, TX 78521-3240 - Phone
- (956) 542-3891
- NPI assigned
- Jul 30, 2019
- Last updated
- Jul 30, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP00008935 | NM | |
| Pharmacist | 183500000X | S023942 | AZ | |
| Pharmacist | 183500000X | 63390 | TX | Primary |
Addresses
Primary practice location
4490 E 14TH St
Brownsville, TX 78521-3240
Mailing address
4490 E 14TH St
Brownsville, TX 78521-3240
Phone (956) 542-3891
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63390 | TX | MD | Professional Counselor |
| S023942 | AZ | MD | Pharmacist |
| RP00008935 | NM | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564444800000",
"number": "1699329540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4490 E 14TH ST",
"city": "BROWNSVILLE",
"state": "TX",
"postal_code": "785213240",
"telephone_number": "956-542-3891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4490 E 14TH ST",
"city": "BROWNSVILLE",
"state": "TX",
"postal_code": "785213240",
"telephone_number": "956-542-3891"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANTOHAC",
"first_name": "GREVELYN KRISTINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-30",
"last_updated": "2019-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NM",
"license": "RP00008935",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S023942",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "63390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brownsville, TX
- Juan Jose Mancillas, M.D.
- Mandala Counseling & Trauma Therapy Center LLC
- Mandos Optical
- Manna Medical Equipment
- Manna Pediatric Therapy Plus
- Manuel G Guajardo Mdpa
- Manuel J. Sanchez, Mdpa (Knee Pain Clinic)
- Jana Marchesano Marchesano
- Marcos P Holtzman (Lighthouse Counseling Center)
- Margarita Lopez (DBA La Amistad Adult Daycare)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.