DIAGNOSTIC CLINIC OF LONGVIEW PHARMACY (NPI# 1447451406) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447451406 |
| Entity Type | Organization |
| Organization Name | DIAGNOSTIC CLINIC OF LONGVIEW PHARMACY |
| Other Organization Name | DIAGNOSTIC CLINIC OF LONGVIEW |
| Practice Address |
709 Hollybrook Dr Suite 4500 Longview TX 75605-2411 |
| Practice Telephone | 9037576042 |
| Mailing Telephone | 9037576042 |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | PHYLLIS CARY (PHARMACIST IN CHARGE) |
| Authorized Official Telephone | 9037576042 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 183500000X | Pharmacist | 22853 | TX | Pharmacy Service Providers |
| X | 261QI0500X |
Clinic/Center Specialization: Infusion Therapy |
21518 | TX | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Diagnostic Clinic of Longview | Other Name - Individual/Organization |
| Street Address |
709 HOLLYBROOK DR SUITE 4500 |
| City | LONGVIEW |
| State | TX |
| Zip Code | 75605-2411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992781090 | Sanford Watkins | Emergency Medicine | 709 Hollybrook Dr, Suite 4500, Longview, TX 75605-2411 | 2005-12-20 |
| 1225550932 | Larry Fulton Holman Jr. | Nurse Practitioner | 709 Hollybrook Dr, Longview, TX 75605-2411 | 2017-07-13 |
| 1184159055 | Ryan M Guillory Md Pa | Pediatrics | 709 Hollybrook Dr, Suite 5605, Longview, TX 75605-2411 | 2017-04-27 |
| 1447524558 | Sau Chi Goretti Lau | Pharmacist | 709 Hollybrook Dr, Suite 100, Longview, TX 75605-2411 | 2012-03-07 |
| 1891095717 | Kristy Loftin-moening | Audiologist | 709 Hollybrook Dr, Suite 5601, Longview, TX 75605-2411 | 2010-10-26 |
| 1093973661 | Jorge Eduardo Massare-rodriguez | Specialist | 709 Hollybrook Dr, Suite 2301, Longview, TX 75605-2411 | 2008-05-29 |
| 1235333808 | Jonathan David Greifenkamp | Internal Medicine | 709 Hollybrook Dr, Suite 2301, Longview, TX 75605-2411 | 2007-06-14 |
| 1407050008 | Kathleen Weindorff Harris | Internal Medicine | 709 Hollybrook Dr, Suite 4500, Longview, TX 75605 | 2007-06-14 |
| 1366646564 | Action Medsource LLC. | Durable Medical Equipment & Medical Supplies | 709 Hollybrook Dr, Suite 3401, Longview, TX 75605-2411 | 2007-06-12 |
| 1972713782 | Phyllis Cary | Pharmacist | 709 Hollybrook Dr, Suite 4500, Longview, TX 75605-2411 | 2007-05-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194353730 | Dusty Rae Hane | Nurse Practitioner | Diagnostic Clinic of Longview, 2901 N Fourth St, Longview, TX 75605 | 2020-03-30 |
| 1831720374 | Kaycee Whatley | Nurse Practitioner | 323 W Hawkins Parkway, Longview, TX 75605 | 2020-02-03 |
| 1245733492 | Somers Pediatrics | Pediatrics | 103 W. Loop 281, Suite 474, Longview, TX 75605 | 2018-03-14 |
| 1467838391 | Piney Woods Er II LLC | Clinic/Center | 120 East Loop 281, Longview, TX 75605 | 2015-08-03 |
| 1386023968 | Elizabeth Ann Heeb Tidwell | Obstetrics & Gynecology | 802 Medical Dr Ste 100, Longview, TX 75605 | 2015-05-28 |
| 1215353651 | Tracy Hicks | Nurse Practitioner | 102 Commander Dr Ste 9, Longview, TX 75605 | 2014-03-10 |
| 1073881280 | Deirdre Scotter | Specialist/Technologist | 201 E Tomlinson Pkwy, Longview, TX 75605 | 2011-12-02 |
| 1316230139 | Traditions Hospice of Longview, LLC | Hospice Care, Community Based | 4362 N Us Hwy 259, Suite B, Longview, TX 75605 | 2011-05-26 |
| 1184916769 | Telema Dikibujiri Nga | Pediatrics | Longview Regional Medical Center, 2901 North Fourth Street, Longview, TX 75605 | 2011-05-13 |
| 1902101108 | The Veta Lewis Behavioral Health Group | Counselor | 1800 S. Judson St., Suite 100, Longview, TX 75605 | 2011-01-19 |
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| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033723168 | Aubren Martin Emberton | Pharmacist | 2609 Windmill Ln, Longview, TX 75601-5953 | 2020-09-05 |
| 1457991127 | Susan Marie Foster | Pharmacist | 1606 Hillmont Ave, Longview, TX 75601-3857 | 2020-01-10 |
| 1639681711 | Cuc Linh Thi Huynh | Pharmacist | 4006 Estes Pwky, Longview, TX 75603 | 2017-10-30 |
| 1285188714 | Alfred Mudoh | Pharmacist | 710 Crepe Myrtle Ln, Longview, TX 75604-6906 | 2016-08-12 |
| 1467865576 | Gunars Arnits | Pharmacist | 2403 E Lynnwood Dr, Longview, WA 98632-5769 | 2014-06-05 |
| 1164702650 | Eunha Do | Pharmacist | 115 E Hawkins Pkwy, Apt 621, Longview, TX 75605-3614 | 2011-08-28 |
| 1316232507 | Kristen Brooks Thompson | Pharmacist | 3092 N Eastman Rd, T2283, Longview, TX 75605-5175 | 2011-06-15 |
| 1386951788 | Joseph Michael Welch | Pharmacist | 364 Triangle Shopping Ctr, Longview, WA 98632-4651 | 2010-09-07 |
| 1285958975 | Travis Mark Dunn | Pharmacist | 1100 Mccann Rd, Longview, TX 75601-4541 | 2010-03-24 |
| 1255668901 | David M Vaughan | Pharmacist | 1778 W Loop 281, Longview, TX 75604 | 2009-11-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.