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General NPI Number Information
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NPI Number | 1093956062
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Entity Type | Organization
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Legal Business Name | LSCC GEORGETOWN PHARMACY- WILLIAMS DRIVE
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 2423 WILLIAMS DR SUITE 109
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City | GEORGETOWN
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State | TX
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Zip | 78628-3200
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Country | US
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Telephone | 512-686-0155
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Fax | 512-869-8482
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Provider Business Mailing Address
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Address Line | 2423 WILLIAMS DR STE 107
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City | GEORGETOWN
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State | TX
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Zip | 78628-3269
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Country | US
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Telephone | 877-800-5722
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN DAVID CALVIN
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Credential |
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Telephone | 877-800-5722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26364
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License Number State | TX
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