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Organization
FIRST LONE STAR PHARMACY GROUP IV LLC
Active
Organization
FIRST LONE STAR PHARMACY GROUP IV LLC
Active
Other names
AXTELL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ELLIOTT (OPERATIONS MANAGER)
(214) 521-9991
Entity
Organization
Contact information
Practice address
1246 S HIGHWAY 377, STE 100, PILOT POINT, TX 76258-4353
(940) 686-2218
(940) 686-9286
Mailing address
1246 S HIGHWAY 377, STE 100, PILOT POINT, TX 76258-4353
(940) 686-2218
(940) 686-9286
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
29669
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141751
—
TX
01
—
2146341
PK
—
Enumeration date
01/27/2006
Last updated
06/12/2024
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