MP SOUTHPARK PHARMACY LLC NPI 1427081447

NPI Information

  • NPI: 1427081447
  • Provider Name: MP SOUTHPARK PHARMACY LLC
  • Classification: Pharmacy - 3336L0003X
  • Specialization: Long Term Care Pharmacy
  • Entity Type: Organization
  • Doing Business As: MYERS DRUG
  • CLIA Number: 45D2247482
  • Address: 29 S CHADB0URNE
    SAN ANGELO, TX
    ZIP 76903
  • Phone: (325) 655-3146

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NPI Details

MP SOUTHPARK PHARMACY LLC is a long term care pharmacy pharmacy in San Angelo, TX. The provider is a pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. MP SOUTHPARK PHARMACY LLC NPI is 1427081447. The provider is registered as an organization entity type.
The provider Is Doing Business As Myers Drug.

The provider's business location address is:

29 S CHADB0URNE
SAN ANGELO, TX
ZIP 76903-891
Phone: (325) 655-3146
Fax: (325) 658-5891

The provider's authorized official is Micah Pratt .
The authorized official title is Owner and has the following contact phone number (806) 548-0590.

The CLIA number assigned to this NPI record is 45D2247482 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Administration of influenza virus vaccine (HCPCS:G0008)
  • Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
  • Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage (HCPCS:90686)
  • Influenza vaccine, quadrivalent derived from cell cultures, preservative and antibiotic free (HCPCS:90674)

The enumeration date for this NPI number is 7/10/2006 and was last updated on 7/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
23336C0003XPharmacyCommunity/Retail Pharmacy31522TEXASNo
33336C0004XPharmacyCompounding PharmacyNo
43336L0003XPharmacyLong Term Care PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
131522OTHERTEXASPHARMACY LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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