MEDICARE: BASTROP MEDICINE SHOP LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1952071334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASTROP MEDICINE SHOP LLC

Provider Business Mailing Address
First Line	:	1001 CHESTNUT ST STE A
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-4053
Country	:	US
Telephone Number	:	512-350-4836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 CHESTNUT ST STE A
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-4053
Country	:	US
Telephone Number	:	512-350-4836
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST/PIC
Name	:	DR. OMAR ALEJANDRO FUENTES CURIEL
Credential	:	PHARMD
Telephone Number	:	512-350-4836

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	06/10/2026

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Directions to “BASTROP MEDICINE SHOP LLC ” Practice Location

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