Provider Demographics
NPI:1417835661
Name:THROCKMORTON DRUG
Entity type:Organization
Organization Name:THROCKMORTON DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WIMBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:254-366-8291
Mailing Address - Street 1:802 N MINTER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:THROCKMORTON
Mailing Address - State:TX
Mailing Address - Zip Code:76483-5357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:802 N MINTER AVE STE C
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483-5357
Practice Address - Country:US
Practice Address - Phone:254-366-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W5 PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy