Active NPI
Reny Jacob Issac, PHARM D
- Pharmacist
- La Porte, TX
National Provider Identifier
1235467911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 41992
- Practice address
- 9705 W Main St
La Porte, TX 77571-4071 - Phone
- (281) 470-7428
- NPI assigned
- Nov 18, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 41992 | TX | Primary |
Addresses
Primary practice location
9705 W Main St
La Porte, TX 77571-4071
Mailing address
9705 W Main St
La Porte, TX 77571-4071
Phone (281) 470-7428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 41992 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- La Porte, TX
- NPI 1306853312
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- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258502400000",
"number": "1235467911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9705 W MAIN ST",
"city": "LA PORTE",
"state": "TX",
"postal_code": "775714071",
"telephone_number": "281-470-7428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9705 W MAIN ST",
"city": "LA PORTE",
"state": "TX",
"postal_code": "775714071",
"telephone_number": "281-470-7428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISSAC",
"first_name": "RENY",
"middle_name": "JACOB",
"name_prefix": "Mr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-11-18",
"last_updated": "2009-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "41992",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Porte, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.