MEDICARE: LAX GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	12639	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2155340	OTHER		PK

General Provider Information

NPI Number	:	1487047874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAX GROUP LLC

Provider Business Mailing Address
First Line	:	8035 PROVIDENCE RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-9716
Country	:	US
Telephone Number	:	704-909-4700
Fax Number	:	704-752-4197

Provider Business Practice Location Address
First Line	:	8035 PROVIDENCE RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8907
Country	:	US
Telephone Number	:	704-909-4700
Fax Number	:	704-752-4197

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VIPUL PATEL
Credential	:	PHARMD
Telephone Number	:	704-909-4700

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	12/15/2022

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Directions to “LAX GROUP LLC ” Practice Location

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