Provider Demographics
NPI:1457848004
Name:HILLCREST PHARMACY, LLC
Entity Type:Organization
Organization Name:HILLCREST PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-394-4456
Mailing Address - Street 1:2650 FM 407 E STE 145-103
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-7012
Mailing Address - Country:US
Mailing Address - Phone:225-937-4716
Mailing Address - Fax:972-767-3134
Practice Address - Street 1:3065 N JOSEY LN STE 60
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5348
Practice Address - Country:US
Practice Address - Phone:972-394-4456
Practice Address - Fax:972-394-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8029759223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy