Organization
SULLIVAN S DRUG LLC
Active
Other names
Sullivan Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODOLFO RANGEL (OWNER/PHARMACIST)
(956) 793-3738
Entity
Organization
Contact information
Practice address
1140 GRAND AVE, BACLIFF, TX 77518-2760
(281) 339-4577
(281) 559-4339
Mailing address
1140 GRAND AVE, BACLIFF, TX 77518-2760
(281) 339-4577
(281) 559-4339
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
13309
TX
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150045
—
TX
01
—
4577219
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/10/2006
Last updated
07/27/2020
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