Eagle Lake Drugstore

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

11754 Issued in TX

Legal business name

EAGLE LAKE DRUGSTORE

Doing business as

EAGLE LAKE DRUG STORE

Practice address

702 S McCarty Ave
Eagle Lake, TX 77434-3212

Phone

(979) 234-2502

Fax

(979) 234-5005

NPI assigned

Feb 1, 2007

Organization subpart

No

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

Authorized official

Name

Sammi L Zarate

Title

Pharmacy Manager

Phone

(979) 234-2502

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• EAGLE LAKE DRUG STORE Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1568509974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S MCCARTY AVE",
            "city": "EAGLE LAKE",
            "state": "TX",
            "postal_code": "774343212",
            "telephone_number": "979-234-2502",
            "fax_number": "979-234-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S MCCARTY AVE",
            "city": "EAGLE LAKE",
            "state": "TX",
            "postal_code": "774343212",
            "telephone_number": "979-234-2502",
            "fax_number": "979-234-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE LAKE DRUGSTORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "ZARATE",
        "authorized_official_first_name": "SAMMI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "979-234-2502"
    },
    "taxonomies": [
        {
            "code": "261QA3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Augmentative Communication",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "11754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108467501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2095769",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAGLE LAKE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EAGLE LAKE DRUG STORE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ramon Omar Cantu, D.O.
• Brenda Joyce Cunningham
• Jessica Daniels
• Don'T Forget About US Elderly Care LLC
• Eagle Lake Community Hospital
• Eagle Lake Nursing and Rehabilitation, LP
• Patricia Marie Eagle
• Melanie Farrell, PA-C
• Brittnee Nicole Flowers
• Linda Harris

• Community/Retail Pharmacy in Eagle Lake, TX
• Providers in Eagle Lake, 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 Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.