Provider Demographics
NPI:1578576096
Name:DURAMED
Entity Type:Organization
Organization Name:DURAMED
Other - Org Name:CORNER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
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:325-247-4155
Practice Address - Fax:325-247-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45922353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144929Medicaid
TX144929Medicaid