Provider Demographics
NPI:1326645086
Name:DURA MED, INC.
Entity Type:Organization
Organization Name:DURA MED, INC.
Other - Org Name:CORNER DRUG LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-247-4155
Mailing Address - Street 1:600 BESSEMER AVE
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:TX
Mailing Address - Zip Code:78643-1608
Mailing Address - Country:US
Mailing Address - Phone:325-247-4155
Mailing Address - Fax:325-247-5554
Practice Address - Street 1:600 BESSEMER AVE
Practice Address - Street 2:
Practice Address - City:LLANO
Practice Address - State:TX
Practice Address - Zip Code:78643-1608
Practice Address - Country:US
Practice Address - Phone:252-474-1553
Practice Address - Fax:325-247-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy