Super Drug Mart, Inc.

Primary specialty

PharmacistTaxonomy code 183500000X

License

20307 Issued in TX

Legal business name

SUPER DRUG MART, INC.

Doing business as

Super Drug Mart

Practice address

5555 Fredericksburg Rd
Suite 105
San Antonio, TX 78229-3500

Phone

(210) 495-7516

Fax

(210) 340-6998

NPI assigned

Jun 12, 2015

Last updated

Jun 12, 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

Mr. Raymond D Ibanez Sr., PHARM.D.

Title

Owner/Pharmacist

Phone

(830) 709-0360

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Super Drug Mart Doing business as

Tax ID family

Super Drug Mart2 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.

• Super Drug Mart Inc

  dba Super Drug Mart

  • Pharmacist
  • Lytle, TX
  • NPI 1679623482
  NPD tax ID

Locations

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434067200000",
    "number": "1447631734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19010 PREIST BLVD",
            "address_2": "SUITE 101",
            "city": "LYTLE",
            "state": "TX",
            "postal_code": "780523486",
            "telephone_number": "830-709-0360",
            "fax_number": "830-709-0363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 FREDERICKSBURG RD",
            "address_2": "SUITE 105",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293500",
            "telephone_number": "210-495-7516",
            "fax_number": "210-340-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER DRUG MART, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-12",
        "last_updated": "2015-06-12",
        "status": "A",
        "authorized_official_last_name": "IBANEZ",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "830-709-0360",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "20307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF PHARMACY",
            "identifier": "20307",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144974",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super Drug Mart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pharmacist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.