Provider Demographics
NPI:1164727749
Name:SECUNDUM ARTEM LLC
Entity Type:Organization
Organization Name:SECUNDUM ARTEM LLC
Other - Org Name:CENTRAL DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-575-4713
Mailing Address - Street 1:3802 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3443
Mailing Address - Country:US
Mailing Address - Phone:361-575-4713
Mailing Address - Fax:361-573-9880
Practice Address - Street 1:3802 N LAURENT ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3443
Practice Address - Country:US
Practice Address - Phone:361-575-4713
Practice Address - Fax:361-573-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
TX273763336C0003X, 3336C0004X, 3336H0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2128795OtherPK
TX143357Medicaid
2128795OtherPK
TX7154750001Medicare NSC
TX338629402Medicaid
TX338629401Medicaid