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General NPI Number Information
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NPI Number | 1124182373
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Entity Type | Organization
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Legal Business Name | LONE STAR PHARMACY LTD
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 1417 E INTERSTATE 30 STE 3
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City | GARLAND
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State | TX
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Zip | 75043-4786
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Country | US
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Telephone | 972-303-7572
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Fax | 972-303-5470
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Provider Business Mailing Address
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Address Line | PO BOX 409244
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City | ATLANTA
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State | GA
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Zip | 30384-9244
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Country | US
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Telephone | 813-318-6135
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Fax | 813-318-6346
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | THOMAS CANERIS
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Credential |
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Telephone | 502-627-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 22335
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License Number State | TX
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