Organization
LONE STAR PAIN MEDICINE PLLC
Active
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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