Organization
SOUTH TEXAS PHARMACY GROUP LLC
Active
Other names
Lakeside Pharmacy South
Organization subpart
No
Provider details
NPI number
Authorized official
TOM CONTRERAS (OWNER/MGR/PHCY TECH)
(956) 725-6337
Entity
Organization
Contact information
Practice address
4151 JAIME ZAPATA MEMORIAL HWY STE 208, LAREDO, TX 78043-4782
(956) 724-2090
(956) 724-2170
Mailing address
4151 BOB BULLOCK LOOP STE 208, LAREDO, TX 78043-4782
(956) 724-2090
(956) 724-2170
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28345
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146700
—
TX
01
—
2136707
PK
—
Enumeration date
05/30/2012
Last updated
10/29/2015
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