John Paul Supak, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

55238 Issued in TX

Practice address

2828 N Bryant Blvd
San Angelo, TX 76903-2865

Phone

(325) 655-4957

Fax

(325) 659-5159

NPI assigned

Aug 4, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • San Angelo, TX
  • NPI 1609125111
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407110400000",
    "number": "1821407941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 N BRYANT BLVD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769032865",
            "telephone_number": "325-655-4957",
            "fax_number": "325-659-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 N BRYANT BLVD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769032865",
            "telephone_number": "325-655-4957",
            "fax_number": "325-659-5159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPAK",
        "first_name": "JOHN",
        "middle_name": "PAUL",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-04",
        "last_updated": "2014-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "55238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Summer Regency SCC LLC
• Jessica Sumrall, O.D.
• Kai M Sun, D.O.
• Stephanie Kay Sun, D.O.
• Sunset Eye Care P.C.
• Morgan Carol Sustaire
• Crystal Sustaita, CRNA
• Lourell E Sutliff, MD
• Lynda Stigall Sutliff, RN, FNP
• Alexa Marie Swingle, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; 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.