Active NPI
Tarrytown Pharmacy LLC
Doing business as Tarrytown Pharmacy
- Community/Retail Pharmacy
- Austin, TX
National Provider Identifier
1942384078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 1812
- Legal business name
- TARRYTOWN PHARMACY LLC
- Doing business as
- Tarrytown Pharmacy
- Practice address
- 2727 Exposition Blvd
Ste 105
Austin, TX 78703-1228 - Phone
- (512) 478-6419
- Fax
- (512) 478-1638
- NPI assigned
- Oct 25, 2006
- 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
- Mark Newberry
- Title
- President
- Phone
- (512) 478-6419
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diabetes Educator Registered Nurse | 163WD0400X | |||
| Pharmacist | 183500000X | |||
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | |||
| Primary Care Clinic/Center | 261QP2300X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1812 | TX | Primary |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
2727 Exposition Blvd
Ste 105
Austin, TX 78703-1228
Mailing address
2727 Exposition Blvd
Ste 105
Austin, TX 78703-1228
Phone (512) 478-6419
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110162 | Medicaid | TX | |
| 2093490 | Other | PK |
Other names 1
- TARRYTOWN PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200511000569 | TX | Part B Supplier - Independent Clinical Laboratory | 0840277836 |
1 other NPI on this enrollment Practice locations: Austin, TX |
| O20200518002063 | TX | Part B Supplier - Pharmacy | 0840277836 | Practice locations: Austin, TX |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
2727 Exposition Blvd
Ste 105
Austin, TX 78703
Phone (512) 478-6419
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1661904000000",
"number": "1942384078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2727 EXPOSITION BLVD",
"address_2": "STE 105",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787031228",
"telephone_number": "512-478-6419",
"fax_number": "512-478-1638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2727 EXPOSITION BLVD",
"address_2": "STE 105",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787031228",
"telephone_number": "512-478-6419",
"fax_number": "512-478-1638"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TARRYTOWN PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-25",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A",
"authorized_official_last_name": "NEWBERRY",
"authorized_official_first_name": "MARK",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "512-478-6419"
},
"taxonomies": [
{
"code": "163WD0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse, Diabetes Educator",
"state": null,
"license": null,
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pharmacist",
"state": null,
"license": null,
"primary": false
},
{
"code": "1835P0018X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "1812",
"primary": true
},
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110162",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2093490",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "TARRYTOWN PHARMACY",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "TARRYTOWN PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.