Healthcare Provider Details

I. General information

NPI: 1285780569
Provider Name (Legal Business Name): SARA L LUMMUS PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N MAIN ST
SAN ANGELO TX
76903-4077
US

IV. Provider business mailing address

902 N MAIN ST
SAN ANGELO TX
76903-4077
US

V. Phone/Fax

Practice location:
  • Phone: 325-658-7555
  • Fax: 325-653-3224
Mailing address:
  • Phone: 325-658-7555
  • Fax: 325-653-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number20271
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: