Provider Demographics
NPI:1538501960
Name:THURMANS PRO-MED PHARMACY LLC
Entity Type:Organization
Organization Name:THURMANS PRO-MED PHARMACY LLC
Other - Org Name:THURMAN'S PRO-MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-572-6337
Mailing Address - Street 1:402 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3949
Mailing Address - Country:US
Mailing Address - Phone:903-572-6337
Mailing Address - Fax:903-572-7455
Practice Address - Street 1:402 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3949
Practice Address - Country:US
Practice Address - Phone:903-572-6337
Practice Address - Fax:903-572-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
TX287633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146828Medicaid
2142476OtherPK