Healthcare Provider Details

I. General information

NPI: 1225497936
Provider Name (Legal Business Name): LANCASTER DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GREEN STREET STE A
LANCASTER MO
63548
US

IV. Provider business mailing address

5908 BRECKENRIDGE PARKWAY
TAMPA FL
33610
US

V. Phone/Fax

Practice location:
  • Phone: 660-457-3220
  • Fax: 660-457-3240
Mailing address:
  • Phone: 813-304-2221
  • Fax: 888-239-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA RIVERA
Title or Position: LICENSING SPECIALIST
Credential:
Phone: 813-304-2221