Healthcare Provider Details

I. General information

NPI: 1063955730
Provider Name (Legal Business Name): PILOT POINT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD TOWN BLVD S SUITE 102
LANTANA TX
76226-3968
US

IV. Provider business mailing address

101 OLD TOWN BLVD S SUITE 102
LANTANA TX
76226-3968
US

V. Phone/Fax

Practice location:
  • Phone: 940-464-4500
  • Fax: 940-464-4533
Mailing address:
  • Phone: 940-464-4500
  • Fax: 940-464-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number31051
License Number StateTX

VIII. Authorized Official

Name: VICKI WOELFEL
Title or Position: PHARMACIST
Credential:
Phone: 214-529-5604