MEDICARE: PORT ARANSAS PHARMACY, L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	23841	TX
2	333600000X	Pharmacy	23841	TX
3	3336C0003X	Community/Retail Pharmacy	23841	TX
4	3336C0004X	Compounding Pharmacy	23841	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942286471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT ARANSAS PHARMACY, L.C.

Provider Business Mailing Address
First Line	:	PO BOX 2407
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75091-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 STATE HIGHWAY 361
Second Line	:
City	:	PORT ARANSAS
State	:	TX
Zip	:	78373-4801
Country	:	US
Telephone Number	:	361-749-1725
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JOHN STOGNER
Credential	:
Telephone Number	:	903-893-0677

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	09/11/2025

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Directions to “PORT ARANSAS PHARMACY, L.C. ” Practice Location

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