Colleyville Drug, Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

COLLEYVILLE DRUG, INC

Doing business as

Regional Pharmacy

Practice address

622 W Main St
Crosbyton, TX 79322-2243

Phone

(806) 675-2001

Fax

(806) 675-7284

NPI assigned

Aug 14, 2006

Last updated

Jul 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Clint Tyler Manske, RPHNPI 1174111710

Title

Owner

Phone

(806) 549-1243

Specialties & licenses 1

Addresses

Other names 1

• REGIONAL PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clint Tyler Manske, PHARMD

  • Pharmacist
  • Crosbyton, TX
  • NPI 1174111710
  NPD Authorized official
• Tarun Patel

  • Pharmacist
  • Crosbyton, TX
  • NPI 1104429596
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1710990387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W MAIN ST",
            "city": "CROSBYTON",
            "state": "TX",
            "postal_code": "793222243",
            "telephone_number": "806-675-2001",
            "fax_number": "806-675-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W MAIN ST",
            "city": "CROSBYTON",
            "state": "TX",
            "postal_code": "793222243",
            "telephone_number": "806-675-2001",
            "fax_number": "806-675-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEYVILLE DRUG, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "MANSKE",
        "authorized_official_first_name": "CLINT",
        "authorized_official_middle_name": "TYLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "806-549-1243",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REGIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "REGIONAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Enrico Gulua Aguas, MD
• Steve B Alley, M D
• Booker Hospital District (Crosbyton Nursing and Rehabilitation Center)
• Crosbyton Clinic Hospital
• Crosbyton Clinic Hospital
• Crosbyton Clinic Hospital
• Crosbyton Clinic Hospital EMS
• Crosbyton Clinic Hospital ER Group

• Community/Retail Pharmacy in Crosbyton, TX
• Providers in Crosbyton, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.