Provider Demographics
NPI:1063955730
Name:PILOT POINT LLC
Entity type:Organization
Organization Name:PILOT POINT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOELFEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-529-5604
Mailing Address - Street 1:101 OLD TOWN BLVD S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-3968
Mailing Address - Country:US
Mailing Address - Phone:940-464-4500
Mailing Address - Fax:940-464-4533
Practice Address - Street 1:101 OLD TOWN BLVD S
Practice Address - Street 2:SUITE 102
Practice Address - City:LANTANA
Practice Address - State:TX
Practice Address - Zip Code:76226-3968
Practice Address - Country:US
Practice Address - Phone:940-464-4500
Practice Address - Fax:940-464-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 333600000X, 3336C0004X
TX310513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149547Medicaid
2165725OtherPK
TX149547Medicaid