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General NPI Number Information
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NPI Number | 1285065870
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Entity Type | Organization
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Legal Business Name | LAKE TRAVIS PHARMACY PARTNERS LLC
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Dates
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Enumeration Date | 12/06/2013
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 12005 BEE CAVE PKWY STE 1A
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City | AUSTIN
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State | TX
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Zip | 78738-6387
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Country | US
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Telephone | 512-608-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 12005 BEE CAVE RD SUITE 1A
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City | AUSTIN
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State | TX
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Zip | 78738
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Country | US
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Telephone | 512-608-9355
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE MCANALLY
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Credential |
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Telephone | 214-734-8878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail 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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28908
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License Number State | TX
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