Provider Demographics
NPI:1417085176
Name:LONE STAR DRUG LLC
Entity Type:Organization
Organization Name:LONE STAR DRUG LLC
Other - Org Name:LONE STAR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-723-5500
Mailing Address - Street 1:1441 S MIDLOTHIAN PKWY
Mailing Address - Street 2:STE 140
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5591
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:STE 140
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-5500
Practice Address - Fax:972-723-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX231753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4510827OtherOTHER ID NUMBER
TX145392Medicaid
4510827OtherOTHER ID NUMBER-COMMERCIAL NUMBER