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General NPI Number Information
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NPI Number | 1437677432
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Entity Type | Organization
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Legal Business Name | DISMUKESRX LLC
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 511 E DAVIS ST
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City | LULING
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State | TX
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Zip | 78648-2317
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Country | US
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Telephone | 830-875-2811
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Fax | 830-875-2283
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Provider Business Mailing Address
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Address Line | PO BOX 1011
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City | COLEMAN
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State | TX
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Zip | 76834-1011
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Country | US
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Telephone | 325-214-2087
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Fax | 325-625-9447
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CATHY ALLEN
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Credential |
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Telephone | 325-625-9448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 31530
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License Number State | TX
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