Provider Demographics
NPI:1083783526
Name:CUB DRUG, INC.
Entity Type:Organization
Organization Name:CUB DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:940-564-5551
Mailing Address - Street 1:116 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76374-1922
Mailing Address - Country:US
Mailing Address - Phone:940-564-5551
Mailing Address - Fax:940-564-2226
Practice Address - Street 1:116 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:TX
Practice Address - Zip Code:76374-1922
Practice Address - Country:US
Practice Address - Phone:940-564-5551
Practice Address - Fax:940-564-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144031Medicaid
TXBC3951096OtherDEA NUMBER
TX0486160001Medicare NSC