Healthcare Provider Details

I. General information

NPI: 1942215587
Provider Name (Legal Business Name): MARTIN TIPTON PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/19/2025
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S TYLER ST
AMARILLO TX
79101-4240
US

IV. Provider business mailing address

PO BOX 30863
AMARILLO TX
79120-0863
US

V. Phone/Fax

Practice location:
  • Phone: 806-373-2812
  • Fax: 806-372-6550
Mailing address:
  • Phone: 806-373-2812
  • Fax: 806-372-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number99-6012
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number19969
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00003537
License Number StateNM

VIII. Authorized Official

Name: J MARK VOGLER
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 806-373-2812