Active NPI
Raymond Purnomo
- Pharmacist
- Denton, TX
National Provider Identifier
1780151894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 45827
- Practice address
- 3305 S Mayhill Rd Ste 101
Denton, TX 76208-6054 - Phone
- (940) 382-0079
- NPI assigned
- Oct 26, 2018
- Last updated
- Oct 26, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 45827 | TX | Primary |
Addresses
Primary practice location
3305 S Mayhill Rd Ste 101
Denton, TX 76208-6054
Mailing address
3126 Impala TRL
Frisco, TX 75034-6219
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Addis Pharmacy Inc | Current | Accepting new patients |
Locations
3305 S Mayhill Rd
Ste 101
Denton, TX 76208
Phone (940) 382-0079
Organizations & group practices 1
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": "1540512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540512000000",
"number": "1780151894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3126 IMPALA TRL",
"city": "FRISCO",
"state": "TX",
"postal_code": "750346219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3305 S MAYHILL RD STE 101",
"city": "DENTON",
"state": "TX",
"postal_code": "762086054",
"telephone_number": "940-382-0079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PURNOMO",
"first_name": "RAYMOND",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-26",
"last_updated": "2018-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "45827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.