Provider Demographics
NPI:1194860262
Name:CITY DRUG STORE OF YOAKUM,INC
Entity Type:Organization
Organization Name:CITY DRUG STORE OF YOAKUM,INC
Other - Org Name:CITY DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:830-857-0877
Mailing Address - Street 1:602 US HIWAY 77A SOUTH -
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995
Mailing Address - Country:US
Mailing Address - Phone:361-293-3351
Mailing Address - Fax:361-293-3351
Practice Address - Street 1:602 US HIWAY 77A SOUTH -
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995
Practice Address - Country:US
Practice Address - Phone:361-293-3351
Practice Address - Fax:361-293-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00604333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130666Medicaid