Provider Demographics
NPI:1346386968
Name:LUMMUS PHARM INC
Entity type:Organization
Organization Name:LUMMUS PHARM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMMUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:325-658-7555
Mailing Address - Street 1:902 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-4077
Mailing Address - Country:US
Mailing Address - Phone:325-658-7555
Mailing Address - Fax:325-653-3224
Practice Address - Street 1:902 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-4077
Practice Address - Country:US
Practice Address - Phone:325-658-7555
Practice Address - Fax:325-653-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336H0001X
TX270173336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2106058OtherPK
TX350086Medicaid
TX350086Medicaid