Organization
HEWITT DRUG
Active
Other names
Lynn's Pharmacy Hewitt
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW DARBY WAGONER RPH (PHARMACIST IN CHARGE)
(254) 733-3032
Entity
Organization
Contact information
Practice address
511 N HEWITT DR, SUITE 1, HEWITT, TX 76643-3000
(254) 666-5000
(254) 666-5002
Mailing address
511 N HEWITT DR, SUITE 1, HEWITT, TX 76643-3000
(254) 666-5000
(254) 666-5002
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
28666
TX
313M00000X
Nursing Facility/Intermediate Care Facility
28666
TX
314000000X
Skilled Nursing Facility
28666
TX
3336C0003X
Community/Retail Pharmacy
Primary
28666
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148899
—
TX
01
—
28666
TEXAS PHARMACY PERMIT
TX
Enumeration date
07/25/2013
Last updated
04/24/2020
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