Active NPI
Marie Rose Mutabaruka, PHARM D
- Pharmacist
- Little Elm, TX
National Provider Identifier
1750098091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 68680
- Practice address
- 14625 Crystal Lake Dr
Little Elm, TX 75068-2767 - Phone
- (972) 855-7523
- NPI assigned
- Nov 4, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 68680 | TX | Primary |
Addresses
Primary practice location
14625 Crystal Lake Dr
Little Elm, TX 75068-2767
Mailing address
14625 Crystal Lake Dr
Little Elm, TX 75068-2767
Phone (972) 855-7523
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68680 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667520000000",
"number": "1750098091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14625 CRYSTAL LAKE DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750682767",
"telephone_number": "972-855-7523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14625 CRYSTAL LAKE DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750682767",
"telephone_number": "972-855-7523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTABARUKA",
"first_name": "MARIE ROSE",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-04",
"last_updated": "2022-11-04",
"certification_date": "2022-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "68680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Elm, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.