Northside Pharmacy LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

30070 Issued in TX

Legal business name

NORTHSIDE PHARMACY LLC

Practice address

207 Wayside Dr
Houston, TX 77011-3625

Phone

(832) 940-0424

Fax

(832) 940-0415

NPI assigned

Sep 23, 2015

Last updated

Aug 3, 2026By 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

Shuntelle J Robinson

Title

Officer

Phone

(832) 940-0424

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Northside Pharmacy LLC

  • Durable Medical Equipment & Medical Supplies
  • Houston, TX
  • NPI 1851107288

  6608308200

  Same PAC ID

Tax ID family

Northside Pharmacy LLC2 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.

• Northside Pharmacy LLC

  • Durable Medical Equipment & Medical Supplies
  • Houston, TX
  • NPI 1851107288
  NPD tax ID

Locations

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785715200000",
    "number": "1770952491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 WAYSIDE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770113625",
            "telephone_number": "832-940-0424",
            "fax_number": "832-940-0415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 WAYSIDE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770113625",
            "telephone_number": "832-940-0424",
            "fax_number": "832-940-0415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2026-08-03",
        "certification_date": "2026-08-03",
        "status": "A",
        "authorized_official_last_name": "ROBINSON",
        "authorized_official_first_name": "SHUNTELLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "832-940-0424"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "30070",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149490",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northside Medical Clinic LLC
• Northside Medical Group, Inc
• Northside Pain Relief Center
• Northside Pathology Group PLLC
• Northside Pathology Group, PLLC
• Northside Pharmacy LLC
• Northside Spine Center LLC
• Northstar Development Company (Horizon Adult Day Services)
• Northstar ER River Oaks LLC
• Northstar Healthcare Surgery Center-Houston, LLC

• Pharmacy in Houston, TX
• Providers in Houston, TX by specialty
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.