Active NPI
Deramed LTC Pharmacy
- Long Term Care Pharmacy
- Mansfield, TX
National Provider Identifier
1801414933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- DERAMED LTC PHARMACY
- Doing business as
- DeraMed Specialty Pharmacy
- Practice address
- 1001 Matlock Rd Ste 105
Mansfield, TX 76063-3443 - Phone
- (817) 592-3636
- NPI assigned
- Jul 6, 2020
- Organization subpart
- Yes
- Parent organization
- DERHANN CO. LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Aderonke Efunogbon
- Title
- Director
- Phone
- (817) 592-3636
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | Primary | ||
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
1001 Matlock Rd Ste 105
Mansfield, TX 76063-3443
Mailing address
1001 Matlock Rd Ste 105
Mansfield, TX 76063-3443
Phone (817) 592-3636
Other names 1
- DeraMed Specialty Pharmacy
National Provider Directory
National Provider Directory- Part of
- Derhann Co LLC
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Specialty Pharmacy
- Mansfield, TX
- NPI 1164997169
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Mansfield, TX
- NPI 1407248875
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593993600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1714694400000",
"number": "1801414933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 MATLOCK RD STE 105",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760633443",
"telephone_number": "817-592-3636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 MATLOCK RD STE 105",
"city": "MANSFIELD",
"state": "TX",
"postal_code": "760633443",
"telephone_number": "817-592-3636"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DERAMED LTC PHARMACY",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DERHANN CO. LLC",
"enumeration_date": "2020-07-06",
"last_updated": "2024-05-03",
"certification_date": "2024-05-03",
"status": "A",
"authorized_official_last_name": "EFUNOGBON",
"authorized_official_first_name": "ADERONKE",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "817-592-3636"
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": true
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "DeraMed Specialty Pharmacy",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "DeraMed Specialty Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mansfield, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.