NPIMap

Organization Active NPI

W5 Pharmacy

  • Community/Retail Pharmacy
  • Breckenridge, TX
National Provider Identifier
1902490428
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
W5 PHARMACY
Practice address
1110 E Walker St
Breckenridge, TX 76424-3824
Phone
(254) 366-8291
NPI assigned
Feb 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Authorized official

Name
Dr. Cody Dean Wimberley, PHARMDNPI 1366060519
Title
Owner/Pic
Phone
(254) 366-8291

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1110 E Walker St
Breckenridge, TX 76424-3824

Mailing address

804 Westridge Cir
Breckenridge, TX 76424-2532
Phone (254) 366-8291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220328000491 TX Part B Supplier - Pharmacy 9739574864 Practice locations: Breckenridge, TX

National Provider Directory

National Provider Directory
Tax ID family
W5 Pharmacy LTC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1110 E Walker St
Breckenridge, TX 76424
Phone (254) 366-8291

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1614124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650326400000",
    "number": "1902490428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 WESTRIDGE CIR",
            "city": "BRECKENRIDGE",
            "state": "TX",
            "postal_code": "764242532",
            "telephone_number": "254-366-8291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 E WALKER ST",
            "city": "BRECKENRIDGE",
            "state": "TX",
            "postal_code": "764243824",
            "telephone_number": "254-366-8291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W5 PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-24",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "WIMBERLEY",
        "authorized_official_first_name": "CODY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "254-366-8291",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Breckenridge, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.