Active NPI
Brackettville Pharmacy, LLC
Doing business as Clinic Pharmacy
- Community/Retail Pharmacy
- Brackettville, TX
National Provider Identifier
1912984626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- BRACKETTVILLE PHARMACY, LLC
- Doing business as
- Clinic Pharmacy
- Practice address
- 201 James St.
Brackettville, TX 78832 - Phone
- (830) 563-9334
- Fax
- (830) 563-9065
- NPI assigned
- Dec 23, 2005
- Last updated
- Jul 11, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Yankton Wyatt, PHARMD
- Title
- President
- Phone
- (432) 523-4861
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
201 James St.
Brackettville, TX 78832
Mailing address
813 Hospital Drive
Andrews, TX 79714
Phone (432) 523-4861
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150055 | Medicaid | TX |
Other names 1
- Clinic Pharmacy
National Provider Directory
National Provider Directory- Tax ID family
- Brackettville Pharmacy LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Main Drug Company
- Community/Retail Pharmacy
- Nixon, TX
- NPI 1154486587
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135296000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1689033600000",
"number": "1912984626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 HOSPITAL DRIVE",
"city": "ANDREWS",
"state": "TX",
"postal_code": "79714",
"telephone_number": "432-523-4861",
"fax_number": "432-524-4918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 JAMES ST.",
"city": "BRACKETTVILLE",
"state": "TX",
"postal_code": "78832",
"telephone_number": "830-563-9334",
"fax_number": "830-563-9065"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRACKETTVILLE PHARMACY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-12-23",
"last_updated": "2023-07-11",
"certification_date": "2023-07-11",
"status": "A",
"authorized_official_last_name": "WYATT",
"authorized_official_first_name": "YANKTON",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "432-523-4861",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150055",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Clinic Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Brackettville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.