Provider Demographics
NPI:1164538849
Name:HILL COUNTRY DRUG LLC
Entity Type:Organization
Organization Name:HILL COUNTRY DRUG LLC
Other - Org Name:LONE STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:THAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:830-964-3615
Mailing Address - Street 1:PO BOX 2229
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-0009
Mailing Address - Country:US
Mailing Address - Phone:830-964-3615
Mailing Address - Fax:830-964-2553
Practice Address - Street 1:1395 SATTLER RD
Practice Address - Street 2:STE 8
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2295
Practice Address - Country:US
Practice Address - Phone:830-964-3615
Practice Address - Fax:830-964-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4572966OtherNABP
TX149640Medicaid
0341620001Medicare ID - Type Unspecified