# BLUEGREEN INDUSTRIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WHEATLAND PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134452212
- **Authorized official:** LYNN CLARK (PIC)
- **Authorized official phone:** (972) 572-1500

## Contact information

- **Practice address:** 1666 N HAMPTON RD STE 100B, DESOTO, TX 75115-8627
- **Practice address phone:** (972) 572-1500
- **Practice address fax:** (972) 572-1505
- **Mailing address:** PO BOX 765311, DALLAS, TX 75376-5311
- **Mailing address phone:** (972) 572-1500
- **Mailing address fax:** (972) 572-1505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 26621 | TX | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/08/2009
- **Last updated:** 07/26/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 146063 | — | TX |
| 01 | — | 2121875 | PK | — |