{"npi":"1851333207","type":"NPI-2","status":"active","name":{"display":"Mauriceville Pharmacy LLC","other":[],"organization_name":"MAURICEVILLE PHARMACY LLC","authorised_official":"Trey Haney"},"specialty":{"primary_taxonomy":"3336C0003X","primary_taxonomy_description":"Community/Retail Pharmacy","slug":"community-retail-pharmacy","schema_org_specialty":null,"all":[{"code":"333600000X","description":"Pharmacy","primary":false,"state":null,"license":null},{"code":"3336C0003X","description":"Community/Retail Pharmacy","primary":true,"state":"TX","license":"23916"}]},"addresses":[{"purpose":"LOCATION","street_1":"10897 HWY 12","city":"MAURICEVILLE","state":"TX","postal_code":"77626","country_code":"US","phone":"4097453784","fax":"4097455910"},{"purpose":"MAILING","street_1":"PO BOX 1149","city":"MAURICEVILLE","state":"TX","postal_code":"776261149","country_code":"US","phone":"4097453784","fax":"4097455910"}],"license":{"state":"TX","number":"23916"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"149069","state":"TX","issuer":null},{"type_code":"01","label":"Other","value":"2096486","state":null,"issuer":"PK"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20211004000997","type_code":"12-A5","type_desc":"PART B SUPPLIER - PHARMACY","state":"TX","pac_id":"8729486907"}]},"enumeration_date":"2006-06-11","last_updated":"2021-09-09","_meta":{"source":"NPPES","snapshot_date":"2021-09-09","doc_url":"https://findmynpi.com/api"}}