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General NPI Number Information
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NPI Number | 1881565935
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Entity Type | Individual
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Provider Name | LANAM JACK MILLICAN
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Gender | Male
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 4700 E PALM VALLEY BLVD
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City | ROUND ROCK
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State | TX
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Zip | 78665-2580
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Country | US
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Telephone | 512-218-9185
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Fax |
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Provider Business Mailing Address
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Address Line | 700 APPLEWOOD DR APT C
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-2713
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Country | US
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Telephone | 806-240-3707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 42747
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License Number State | TX
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