Healthcare Provider Details

I. General information

NPI: 1992710594
Provider Name (Legal Business Name): AUTELL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246-A1 HWY 377 STE 200
PILOT POINT TX
76258
US

IV. Provider business mailing address

1246-A1 HWY 377 STE 200
PILOT POINT TX
76258
US

V. Phone/Fax

Practice location:
  • Phone: 940-686-2140
  • Fax: 940-686-9218
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number19116
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARY AUTELL
Title or Position: TREASURER
Credential: CPHT
Phone: 940-686-2218