Organization
LONE STAR PAIN MEDICINE PLLC
Active
Other names
Town Creek Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMIE MISKIMINS (SENIOR MANAGER)
(817) 572-0009
Entity
Organization
Contact information
Practice address
907 EUREKA ST STE B, WEATHERFORD, TX 76086-5880
(817) 458-5292
(817) 599-3456
Mailing address
1620 W. NORTHWEST HWY, STE. 100, GRAPEVINE, TX 76051
(817) 572-0009
(817) 720-1039
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29653
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2149304
PK
—
Enumeration date
12/23/2014
Last updated
07/19/2018
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