Super Rockwall Drugstore,LP

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

22390 Issued in TX

Legal business name

SUPER ROCKWALL DRUGSTORE,LP

Doing business as

Super Drug

Practice address

3021 Ridge Rd
Suite 103
Rockwall, TX 75032-5806

Phone

(972) 772-0500

Fax

(972) 772-5512

NPI assigned

Feb 19, 2007

Last updated

Mar 11, 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

Miss Marites Talavera Serna, RPHNPI 1447046289

Title

President

Phone

(972) 772-0500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SUPER DRUG Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marites Talavera Serna

  • Pharmacist
  • Dallas, TX
  • NPI 1447046289
  NPD Authorized official

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1467596817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 RIDGE RD",
            "address_2": "SUITE 103",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750325806",
            "telephone_number": "972-772-0500",
            "fax_number": "972-772-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 RIDGE RD",
            "address_2": "SUITE 103",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750325806",
            "telephone_number": "972-772-0500",
            "fax_number": "972-772-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPER ROCKWALL DRUGSTORE,LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "SERNA",
        "authorized_official_first_name": "MARITES",
        "authorized_official_middle_name": "TALAVERA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-772-0500",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "22390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145240",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS PHARMACY LICENSE",
            "identifier": "22390",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SUPER DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Rockwall, TX
• Providers in Rockwall, 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 Mar 11, 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.