Provider Demographics
NPI:1194860262
Name:CITY DRUG OF YOAKUM, INC.
Entity type:Organization
Organization Name:CITY DRUG OF YOAKUM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-293-2181
Mailing Address - Street 1:602 US HIGHWAY 77A S
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-1300
Mailing Address - Country:US
Mailing Address - Phone:361-293-2181
Mailing Address - Fax:361-293-3351
Practice Address - Street 1:602 US HIGHWAY 77A S
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-1300
Practice Address - Country:US
Practice Address - Phone:361-293-2181
Practice Address - Fax:361-293-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130666Medicaid