Provider Demographics
NPI:1265547202
Name:YUM PHARMACIES INC
Entity type:Organization
Organization Name:YUM PHARMACIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-495-4711
Mailing Address - Street 1:1215 W BUCKINGHAM RD
Mailing Address - Street 2:STE B
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 W BUCKINGHAM RD
Practice Address - Street 2:STE B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-4533
Practice Address - Country:US
Practice Address - Phone:972-495-4711
Practice Address - Fax:972-675-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17500333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4599479OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TX1445581Medicaid