Healthcare Provider Details

I. General information

NPI: 1326154113
Provider Name (Legal Business Name): FIRST LONE STAR PHARMACY GROUP IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 HWY 3773 STE 200
PILOT POINT TX
76258
US

IV. Provider business mailing address

1246 S HIGHWAY 377 SUITE 200
PILOT POINT TX
76258-4353
US

V. Phone/Fax

Practice location:
  • Phone: 940-686-2140
  • Fax: 940-686-9286
Mailing address:
  • Phone: 940-686-2140
  • Fax: 940-686-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number29469
License Number StateTX

VIII. Authorized Official

Name: MARK ELLIOT
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 214-521-9991