Provider Demographics
NPI:1255927703
Name:EAGLE PHARMACY HIDEAWAY
Entity type:Organization
Organization Name:EAGLE PHARMACY HIDEAWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DROBLYN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:903-881-5610
Mailing Address - Street 1:1404 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-6267
Mailing Address - Country:US
Mailing Address - Phone:903-881-5752
Mailing Address - Fax:
Practice Address - Street 1:14077 FM 849
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-5160
Practice Address - Country:US
Practice Address - Phone:903-881-5752
Practice Address - Fax:888-374-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33566OtherSTATE BOARD OF PHARMACY