Provider Demographics
NPI:1578651683
Name:LUPARELLOS CORNER PHARMACY LLC
Entity Type:Organization
Organization Name:LUPARELLOS CORNER PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NIPUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-593-3800
Mailing Address - Street 1:111 S WILLIAM BARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4541
Mailing Address - Country:US
Mailing Address - Phone:281-593-3800
Mailing Address - Fax:281-593-2928
Practice Address - Street 1:3570 FANNETT RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-1365
Practice Address - Country:US
Practice Address - Phone:409-842-3222
Practice Address - Fax:409-842-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX031433336C0003X
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093576OtherPK
TX140334Medicaid