EAGLE LAKE DRUGSTORE NPI 1568509974

NPI Information

NPI: 1568509974
Provider Name: EAGLE LAKE DRUGSTORE
Classification: Pharmacy - 3336C0003X
Specialization: Community/Retail Pharmacy
Entity Type: Organization
Doing Business As: EAGLE LAKE DRUG STORE
Address: 702 S MCCARTY AVE
EAGLE LAKE, TX
ZIP 77434
Phone: (979) 234-2502

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NPI Details

EAGLE LAKE DRUGSTORE is a community/retail pharmacy pharmacy in Eagle Lake, TX. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. EAGLE LAKE DRUGSTORE NPI is 1568509974. The provider is registered as an organization entity type.
The provider Is Doing Business As Eagle Lake Drug Store.

The provider's business location address is:

702 S MCCARTY AVE
EAGLE LAKE, TX
ZIP 77434-212
Phone: (979) 234-2502
Fax: (979) 234-5005

The provider's authorized official is Sammi L Zarate .
The authorized official title is Pharmacy Manager and has the following contact phone number (979) 234-2502.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

Administration of influenza virus vaccine (HCPCS:G0008)
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
Fee covid-19 vac 14 res (HCPCS:0134A)
Adm sarscov2 50mcg/0.25mlbst (HCPCS:0064A)
Adm sarscov2 100mcg/0.5ml3rd (HCPCS:0013A)
Adm sarscov2 30mcg/0.3ml bst (HCPCS:0004A)

The enumeration date for this NPI number is 2/1/2007 and was last updated on 6/12/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA3000X	Clinic/Center	Augmentative Communication			No
2	332B00000X	Durable Medical Equipment & Medical Supplies				No
3	333600000X	Pharmacy				No
4	3336C0003X	Pharmacy	Community/Retail Pharmacy	11754	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	108467501	MEDICAID	TEXAS
2	2095769	OTHER		PK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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