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General NPI Number Information
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NPI Number | 1982092102
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Entity Type | Organization
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Legal Business Name | LONE STAR PAIN MEDICINE PLLC
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Dates
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Enumeration Date | 12/23/2014
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 907 EUREKA ST STE B
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City | WEATHERFORD
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State | TX
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Zip | 76086-5880
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Country | US
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Telephone | 817-458-5292
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Fax | 817-599-3456
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Provider Business Mailing Address
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Address Line | 1620 W. NORTHWEST HWY STE. 100
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City | GRAPEVINE
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State | TX
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Zip | 76051
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Country | US
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Telephone | 817-572-0009
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Fax | 817-720-1039
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Authorized Official
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Title or Position | SENIOR MANAGER
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Name | TAMMIE MISKIMINS
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Credential |
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Telephone | 817-572-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 29653
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License Number State | TX
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