Healthcare Provider Details

I. General information

NPI: 1568982858
Provider Name (Legal Business Name): LAXMI VINA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 09/23/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 S DUKE ST
LANCASTER PA
17602-4206
US

IV. Provider business mailing address

1611 ETHAN DR
WYOMISSING PA
19610-1275
US

V. Phone/Fax

Practice location:
  • Phone: 717-690-2700
  • Fax:
Mailing address:
  • Phone: 710-690-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP482729
License Number StatePA

VIII. Authorized Official

Name: YAGNESHKUMAR PATEL
Title or Position: OWNER
Credential:
Phone: 717-690-2700