Provider Demographics
NPI:1013657626
Name:DISMUKESRX LLC
Entity type:Organization
Organization Name:DISMUKESRX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-214-2087
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76834-1011
Mailing Address - Country:US
Mailing Address - Phone:325-518-8888
Mailing Address - Fax:325-219-5286
Practice Address - Street 1:511 E DAVIS ST
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648-2317
Practice Address - Country:US
Practice Address - Phone:830-875-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DISMUKESRX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-31
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy