Provider Demographics
NPI:1699320309
Name:THURMANS PRO-MED PHARMACY LLC (LONG TERM CARE DIV)
Entity type:Organization
Organization Name:THURMANS PRO-MED PHARMACY LLC (LONG TERM CARE DIV)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-572-6337
Mailing Address - Street 1:402 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3949
Mailing Address - Country:US
Mailing Address - Phone:903-572-6337
Mailing Address - Fax:903-572-7455
Practice Address - Street 1:402 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3949
Practice Address - Country:US
Practice Address - Phone:903-572-6337
Practice Address - Fax:903-572-7455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THURMAN'S PRO-MED PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322209OtherPTAN
TX146828Medicaid