Active NPI
Jeffery Wayne Offutt, RPH
- Pharmacist
- Longview, TX
National Provider Identifier
1972966935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 35634
- Practice address
- 1107 E Marshall Ave
Longview, TX 75601-5602 - Phone
- (903) 758-2610
- Fax
- (903) 758-7081
- NPI assigned
- Mar 29, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 35634 | TX | Primary |
Addresses
Primary practice location
1107 E Marshall Ave
Longview, TX 75601-5602
Mailing address
1107 E Marshall Ave
Longview, TX 75601-5602
Phone (903) 758-2610
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35634 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459209600000",
"number": "1972966935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1107 E MARSHALL AVE",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756015602",
"telephone_number": "903-758-2610",
"fax_number": "903-758-7081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1107 E MARSHALL AVE",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756015602",
"telephone_number": "903-758-2610",
"fax_number": "903-758-7081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OFFUTT",
"first_name": "JEFFERY",
"middle_name": "WAYNE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-29",
"last_updated": "2016-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "35634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.