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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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