Active NPI
Queenette Chimeucheya Otamiri
- Pharmacist
- Tyler, TX
National Provider Identifier
1891549911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 73872
- Practice address
- 1620 S Broadway Ave
Tyler, TX 75701-4260 - Phone
- (903) 533-0367
- Fax
- (903) 533-1063
- NPI assigned
- Apr 15, 2024
- 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 | 73872 | TX | Primary |
Addresses
Primary practice location
1620 S Broadway Ave
Tyler, TX 75701-4260
Mailing address
1620 S Broadway Ave
Tyler, TX 75701-4260
Phone (903) 533-0367
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73872 | TX | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1620 S Broadway Ave
Tyler, TX 75701
Phone (903) 533-0367
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713139200000",
"number": "1891549911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 S BROADWAY AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757014260",
"telephone_number": "903-533-0367",
"fax_number": "903-533-1063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 S BROADWAY AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757014260",
"telephone_number": "903-533-0367",
"fax_number": "903-533-1063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTAMIRI",
"first_name": "QUEENETTE",
"middle_name": "CHIMEUCHEYA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-15",
"last_updated": "2024-04-15",
"certification_date": "2024-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "73872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.