The Pharmacy Shop, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

License

24235 Issued in TX

Legal business name

THE PHARMACY SHOP, INC.

Practice address

1602 Rock Prairie Rd
Suite 1000
College Station, TX 77845-8306

Phone

(979) 764-4100

NPI assigned

Nov 18, 2005

Organization subpart

No

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

Authorized official

Name

Judi Henneke, R. PH.

Title

Owner

Phone

(979) 776-6800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Pharmacy Shop II Doing business as

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962484535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD",
            "address_2": "SUITE 1000",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 ROCK PRAIRIE RD",
            "address_2": "SUITE 1000",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458306",
            "telephone_number": "979-764-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PHARMACY SHOP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENNEKE",
        "authorized_official_first_name": "JUDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "979-776-6800",
        "authorized_official_credential": "R. PH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "24235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145596",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pharmacy Shop II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacy in College Station, TX
• Providers in College Station, TX by specialty
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.