Provider Demographics
NPI:1457458382
Name:SUMARK LLC
Entity Type:Organization
Organization Name:SUMARK LLC
Other - Org Name:YOAKUM DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCY/MNGR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-741-7455
Mailing Address - Street 1:210 NELSON ST
Mailing Address - Street 2:STE E
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-2750
Mailing Address - Country:US
Mailing Address - Phone:361-741-7455
Mailing Address - Fax:361-741-7457
Practice Address - Street 1:210 NELSON ST
Practice Address - Street 2:STE E
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-2750
Practice Address - Country:US
Practice Address - Phone:361-741-7455
Practice Address - Fax:361-741-7457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX239663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145528Medicaid
4525195OtherNCPDP PROVIDER IDENTIFICATION NUMBER