Sullivan S Drug LLC
Organization Active NPI Community/Retail Pharmacy · Bacliff, TX
NPI 1093726580 · NPPES record last updated Jul 27, 2020
Key facts
- NPI
- 1093726580
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SULLIVAN S DRUG LLC
- Practice address
- 1140 Grand Ave
Bacliff, TX 77518-2760 - Phone
- (281) 339-4577
- Fax
- (281) 559-4339
- NPI assigned
- Aug 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Rodolfo Rangel
- Title
- Owner/Pharmacist
- Phone
- (956) 793-3738
Corporate family (same tax ID) 1
Practitioners 6
-
Rodolfo Rangel, PHARMD
-
Christopher Demmeck, PHARMD
-
Joe D Sullivan Jr., RPH
-
Sandra Evans Webb, RPH
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200618002932 | TX | DME Supplier - Pharmacy | 4688096720 | Practice locations: Bacliff, TX |
| O20200624000522 | TX | Part B Supplier - Pharmacy | 4688096720 | Practice locations: Bacliff, TX |
National Provider Directory
- Tax ID family
- Sullivan Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 13309 | TX | |
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1140 Grand Ave
Bacliff, TX 77518-2760
Mailing address
1140 Grand Ave
Bacliff, TX 77518-2760
Phone (281) 339-4577
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 150045 | Medicaid | TX | |
| 4577219 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names
- Sullivan Pharmacy
Other providers in Bacliff, TX
- Stephanie Montoya
- Truc Nguyen
- Chacko Pulparampil
- Spring Minor Care LLC
- Stephen F Austin Community Health Center,Inc
- Sullivan S Drug LLC
- Joe D Sullivan Jr.
- Top Line Trucking LLC
- Sarah Walsh
- Sandra Evans Webb
All providers in Bacliff, TX · Community/Retail Pharmacy in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.