South Texas Pharmacy Group LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

28345 Issued in TX

Legal business name

SOUTH TEXAS PHARMACY GROUP LLC

Doing business as

Lakeside Pharmacy South

Practice address

4151 Jaime Zapata Memorial Hwy Ste 208
Laredo, TX 78043-4782

Phone

(956) 724-2090

Fax

(956) 724-2170

NPI assigned

May 30, 2012

Last updated

Oct 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tom Contreras

Title

Owner/MGR/Phcy Tech

Phone

(956) 725-6337

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Lakeside Pharmacy South Doing business as

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

{
    "created_epoch": "1338336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446076800000",
    "number": "1306107073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4151 BOB BULLOCK LOOP STE 208",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780434782",
            "telephone_number": "956-724-2090",
            "fax_number": "956-724-2170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 JAIME ZAPATA MEMORIAL HWY STE 208",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780434782",
            "telephone_number": "956-724-2090",
            "fax_number": "956-724-2170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH TEXAS PHARMACY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-30",
        "last_updated": "2015-10-29",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "OWNER/MGR/PHCY TECH",
        "authorized_official_telephone_number": "956-725-6337"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "28345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146700",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2136707",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Pharmacy South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Texas Health Centers, Inc
• South Texas Hearing
• South Texas Medical Equipment & Supplies
• South Texas Medx, LLC
• South Texas Optometrist PC (Galo Eye Center)
• South Texas Physical Therapy Inc
• South Texas Primary Care, Inc.
• South Texas Therapy Services, Inc
• Joe Sowunmi, R.PH.
• Special Mobility, Inc

• Community/Retail Pharmacy in Laredo, TX
• Providers in Laredo, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.