Organization
EAGLE LAKE DRUGSTORE
Active
Other names
EAGLE LAKE DRUG STORE
Organization subpart
No
Provider details
NPI number
Authorized official
SAMMI L ZARATE (PHARMACY MANAGER)
(979) 234-2502
Entity
Organization
Contact information
Practice address
702 S MCCARTY AVE, EAGLE LAKE, TX 77434-3212
(979) 234-2502
(979) 234-5005
Mailing address
702 S MCCARTY AVE, EAGLE LAKE, TX 77434-3212
(979) 234-2502
(979) 234-5005
Taxonomy
Speciality
Code
Description
License number
State
261QA3000X
Augmentative Communication Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11754
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108467501
—
TX
01
—
2095769
PK
—
Enumeration date
02/01/2007
Last updated
06/12/2024
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