First Lone Star Pharmacy Group LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

27123 Issued in TX

Legal business name

FIRST LONE STAR PHARMACY GROUP LLC

Practice address

906 NE Big Bend TRL
Glen Rose, TX 76043-4909

Phone

(254) 897-2711

Fax

(254) 897-3751

NPI assigned

Aug 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonathan P Lipe, PHARM.D.

Title

Managing Partner

Phone

(214) 521-9991

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• GLEN ROSE DISCOUNT DRUG Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Angela Adams, RPH

  • Pharmacist
  • Glen Rose, TX
  • NPI 1528291614
  NPD (past)
• Mary Linda Moss, M.D.

  • Diagnostic Radiology Physician
  • Jackson, MS
  • NPI 1649286600
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1831100320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6901 PRESTON RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752051136",
            "telephone_number": "214-521-9991",
            "fax_number": "214-521-1649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 NE BIG BEND TRL",
            "city": "GLEN ROSE",
            "state": "TX",
            "postal_code": "760434909",
            "telephone_number": "254-897-2711",
            "fax_number": "254-897-3751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST LONE STAR PHARMACY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "LIPE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "214-521-9991",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146382",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "4548876",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLEN ROSE DISCOUNT DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Glen Rose, TX
• Providers in Glen Rose, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.