Peach Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PEACH PHARMACY, LLC

Practice address

2401 W Pioneer Pkwy Ste 117
Pantego, TX 76013-6038

Phone

(682) 347-4022

Fax

(682) 347-4021

NPI assigned

Oct 10, 2019

Organization subpart

No

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

Authorized official

Name

Ikeeya Hunt

Title

Owner

Phone

(682) 347-4022

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Peach Pharmacy Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandon Nnamdi Ogbodu, BRANDON

  • Pharmacist
  • Humble, TX
  • NPI 1801442496
  NPD

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1841832912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 W PIONEER PKWY STE 117",
            "city": "PANTEGO",
            "state": "TX",
            "postal_code": "760136038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W PIONEER PKWY STE 117",
            "city": "PANTEGO",
            "state": "TX",
            "postal_code": "760136038",
            "telephone_number": "682-347-4022",
            "fax_number": "682-347-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "HUNT",
        "authorized_official_first_name": "IKEEYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "682-347-4022"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHAMARCY LICENSE",
            "identifier": "32863",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "691078",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "peachespharmacy.com",
            "affiliation": "N",
            "address_1": "2401 W Pioneer Pkwy Ste 117",
            "city": "Pantego",
            "state": "TX",
            "country_code": "US",
            "postal_code": "760136038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Peach Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Painted Halos LLC
• Palmtree Healthcare Services
• Pantego Injury Clinic Inc
• Jonathan Parks, DC
• Ashley Parrish, LMSW
• Jeffrey Carl Pedersen, D.C.
• Karina Perez, PA-C
• Julie Blake Peterson, LCSW
• Eric M Pike, DPT
• Dagoberto Pozos Jr., PT, DPT

• Community/Retail Pharmacy in Pantego, TX
• Providers in Pantego, 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 Oct 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.