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General NPI Number Information
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NPI Number | 1659879997
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Entity Type | Organization
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Legal Business Name | LAMAR PLAZA DRUG STORE LA&B, LLC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 1509 S LAMAR BLVD STE 550
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City | AUSTIN
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State | TX
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Zip | 78704-2988
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Country | US
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Telephone | 512-442-6777
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Fax | 512-442-0555
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Provider Business Mailing Address
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Address Line | 1509 S LAMAR BLVD STE 550
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City | AUSTIN
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State | TX
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Zip | 78704-2988
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Country | US
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Telephone | 512-442-6777
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Fax | 512-442-0555
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Authorized Official
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Title or Position | CO-OWNER, PHAMD
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Name | LYNH NGOC PHAM WARNKEN
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Credential |
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Telephone | 512-442-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 26383
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License Number State | TX
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