Provider Demographics
NPI:1275648214
Name:EUBANK DRUG LLC
Entity Type:Organization
Organization Name:EUBANK DRUG LLC
Other - Org Name:EUBANK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:EUBANK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:254-694-3314
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-0487
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1510 N. BRAZOS
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692
Practice Address - Country:US
Practice Address - Phone:254-694-3314
Practice Address - Fax:254-694-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
TX242403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011153602Medicaid
4533697OtherNCPDP PROVIDER IDENTIFICATION NUMBER
TX148586Medicaid
TX011153601Medicaid