Provider Demographics
NPI:1982947057
Name:LONGHORN PHARMACY
Entity Type:Organization
Organization Name:LONGHORN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYKENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-330-2253
Mailing Address - Street 1:2301 S HAMPTON RD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-1650
Mailing Address - Country:US
Mailing Address - Phone:817-919-1609
Mailing Address - Fax:817-249-9596
Practice Address - Street 1:2301 S HAMPTON RD
Practice Address - Street 2:SUITE 850
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:817-919-1609
Practice Address - Fax:817-249-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy