OrganizationActive
Super Drug Mart Inc
NPI 1679623482 · Pharmacist · Lytle, TX
Provider details
- NPI number
- 1679623482
- Entity type
- Organization
- Primary specialty
- PharmacistPharmacy Service Providers
- Organization subpart
- No
- Authorized official
- Raymond Ibanez, Owner/Pharmacist(210) 884-2543
- License
- 20307 (TX)
Specialties & taxonomies
Pharmacy Service Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
19010 Priest Blvd
Lytle, TX 78052
Phone: (830) 709-0360
Fax: (830) 709-0363
Street-level locationGet directions
Mailing address
19010 Priest Blvd
Lytle, TX 78052
Other names (DBA / former)
- Doing business as
- Super Drug Mart
Registry dates
- Enumerated
- 2007-01-12
- Last updated
- 2015-05-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.