Organization
MARILYN DEVERE
Active
Other names
Dismukes Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN DEVERE (OWNER)
(830) 875-2811
Entity
Organization
Contact information
Practice address
511 E DAVIS ST, LULING, TX 78648-2317
(830) 875-2811
(830) 875-2283
Mailing address
511 E DAVIS ST, LULING, TX 78648-2317
(830) 875-2811
(830) 875-2283
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30810
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145690
—
TX
01
—
2160645
PK
—
Enumeration date
10/10/2006
Last updated
02/21/2017
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