Provider Demographics
NPI:1477742385
Name:THE PFLUGERVILLE PHARMACY
Entity Type:Organization
Organization Name:THE PFLUGERVILLE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:ONEIL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-990-5226
Mailing Address - Street 1:15608 SPRING HILL LN
Mailing Address - Street 2:114
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3312
Mailing Address - Country:US
Mailing Address - Phone:512-990-5226
Mailing Address - Fax:512-251-5762
Practice Address - Street 1:15608 SPRING HILL LN
Practice Address - Street 2:114
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3312
Practice Address - Country:US
Practice Address - Phone:512-990-5226
Practice Address - Fax:512-251-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136133336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143608Medicaid
4581345OtherNABP