Sullivan S Drug LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

13309 Issued in TX

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

Feb 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rodolfo RangelNPI 1114232295

Title

Owner

Phone

(956) 793-3738

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Sullivan Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Sullivan Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sullivan S Drug LLC

  • Community/Retail Pharmacy
  • Bacliff, TX
  • NPI 1093726580
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rodolfo Rangel, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Harlingen, TX
  • NPI 1114232295
  NPD Authorized official
• Andrew McDonald II

  • Pharmacist
  • Santa Fe, TX
  • NPI 1346874377
  NPD
• Christopher Demmeck, PHARMD

  • Pharmacist
  • Bacliff, TX
  • NPI 1407497266
  NPD (past)
• Joe D Sullivan Jr., RPH

  • Pharmacist
  • Bacliff, TX
  • NPI 1124114632
  NPD (past)
• Sandra Evans Webb, RPH

  • Pharmacist
  • Bacliff, TX
  • NPI 1326678806
  NPD (past)
• Leslie Williams

  • Pharmacist
  • Bacliff, TX
  • NPI 1801427166
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1215064340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 GRAND AVE",
            "city": "BACLIFF",
            "state": "TX",
            "postal_code": "775182760",
            "telephone_number": "281-339-4577",
            "fax_number": "281-559-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 GRAND AVE",
            "city": "BACLIFF",
            "state": "TX",
            "postal_code": "775182760",
            "telephone_number": "281-339-4577",
            "fax_number": "281-559-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN S DRUG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A",
        "authorized_official_last_name": "RANGEL",
        "authorized_official_first_name": "RODOLFO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "956-793-3738"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "13309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011509901",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010086901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Truc Nguyen, PHYSICIAN ASSISTANT
• Chacko Pulparampil, M.D.
• Spring Minor Care LLC
• Stephen F Austin Community Health Center,Inc
• Sullivan S Drug LLC
• Joe D Sullivan Jr., RPH
• Top Line Trucking LLC
• Sarah Walsh
• Sandra Evans Webb, RPH
• Leslie Williams

• All providers in Bacliff, TX
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.