MEDICARE: LAXWOOD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1316520455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAXWOOD, LLC

Provider Business Mailing Address
First Line	:	3039 SOUTH BLVD STE F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1866
Country	:	US
Telephone Number	:	980-443-4910
Fax Number	:

Provider Business Practice Location Address
First Line	:	3039 SOUTH BLVD STE F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1866
Country	:	US
Telephone Number	:	980-443-4910
Fax Number	:	980-999-5664

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VIPUL BHARATBHAI PATEL
Credential	:	PHARMD
Telephone Number	:	980-443-4910

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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Directions to “LAXWOOD, LLC ” Practice Location

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