=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568557635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL PHARMACY ENTERPRISES OF LANCASTER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 W PLEASANT RUN RD STE 250
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75146-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-223-2623
-----------------------------------------------------
Fax | 972-230-0923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 W PLEASANT RUN RD STE 250
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75146-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-223-2623
-----------------------------------------------------
Fax | 972-230-0923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHEAL PETERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-223-2623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 10181
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------