Provider Demographics
NPI:1720647027
Name:HEALTHMARK PHARMACY, LLC
Entity Type:Organization
Organization Name:HEALTHMARK PHARMACY, LLC
Other - Org Name:SOUTHERN STAR PHARMACY 003
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-702-2006
Mailing Address - Street 1:2436 S INTERSTATE 35 E STE 336B
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4900
Mailing Address - Country:US
Mailing Address - Phone:469-702-2006
Mailing Address - Fax:
Practice Address - Street 1:2436 S I 35 E STE 336B
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-4900
Practice Address - Country:US
Practice Address - Phone:469-702-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy