MEDICARE: PRIDE PHARMACY - CARLISLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649146929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIDE PHARMACY - CARLISLE LLC

Provider Business Mailing Address
First Line	:	4003 LEMMON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3737
Country	:	US
Telephone Number	:	214-954-7389
Fax Number	:	855-716-7525

Provider Business Practice Location Address
First Line	:	4003 LEMMON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3737
Country	:	US
Telephone Number	:	214-954-7389
Fax Number	:	855-716-7525

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL HAYEK
Credential	:
Telephone Number	:	202-255-2012

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	12/09/2025

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