Space City Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SPACE CITY PHARMACY LLC

Practice address

902 S Friendswood Dr Ste E
Friendswood, TX 77546-5154

Phone

(832) 569-5062

Fax

(832) 569-5064

NPI assigned

Sep 4, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Justin Moore

Title

Managing Member

Phone

(832) 569-5062

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Space City Pharmacy Other name

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

{
    "created_epoch": "1567555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626652800000",
    "number": "1982253738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 S FRIENDSWOOD DR STE E",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775465154",
            "telephone_number": "832-569-5062",
            "fax_number": "832-569-5064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 S FRIENDSWOOD DR STE E",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775465154",
            "telephone_number": "832-569-5062",
            "fax_number": "832-569-5064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE CITY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-04",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "832-569-5062",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY LICENSE",
            "identifier": "32841",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Space City Pharmacy",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Space City Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Estephanie Karina Soto
• South Texas Foot Specialist, PA
• Southfriendswood Dental Association
• Space City NP Services
• Space City Pediatric Dentistry
• Corrinia Y. Speed, MCD-CCC/SLP
• Spuhler Medical Associates, PA
• Wanda P Spuhler, M.D.
• Michelle Lauren Squires, PA-C
• Lori Brown Steiger, MSN, AGNP-C

• All providers in Friendswood, TX
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2021; 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.