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
- 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 and National Provider Directory roles.
-
- Pharmacy
- Brownsville, TX
- NPI 1003821026
-
- Pharmacy
- Longview, TX
- NPI 1629956545
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
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.