Healthcare Provider Details

I. General information

NPI: 1346386968
Provider Name (Legal Business Name): LUMMUS PHARM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/18/2017
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 TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number27017
License Number StateTX

VIII. Authorized Official

Name: SARA LUMMUS
Title or Position: CORP OFFICER
Credential: PHD
Phone: 325-658-7555