Healthcare Provider Details

I. General information

NPI: 1063995280
Provider Name (Legal Business Name): HYLANDS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 N. BILL MACK ST
SHAMROCK TX
79079
US

IV. Provider business mailing address

PO BOX 230
WHEELER TX
79096-0230
US

V. Phone/Fax

Practice location:
  • Phone: 806-256-3111
  • Fax: 806-256-3551
Mailing address:
  • Phone: 806-826-5561
  • Fax: 806-826-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL MCENTIRE
Title or Position: OWNER
Credential:
Phone: 806-826-5561