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General NPI Number Information
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NPI Number | 1457458382
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Entity Type | Organization
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Legal Business Name | SUMARK LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 210 NELSON ST STE E
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City | YOAKUM
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State | TX
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Zip | 77995-2750
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Country | US
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Telephone | 361-741-7455
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Fax | 361-741-7457
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Provider Business Mailing Address
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Address Line | 210 NELSON ST STE E
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City | YOAKUM
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State | TX
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Zip | 77995-2750
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Country | US
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Telephone | 361-741-7455
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Fax | 361-741-7457
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Authorized Official
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Title or Position | PHCY/MNGR
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Name | KELLI SCHLEY
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Credential |
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Telephone | 361-741-7455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 23966
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License Number State | TX
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