MEDICARE: LAKEVIEW PHARMACY 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	:	1366083255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW PHARMACY LLC

Provider Business Mailing Address
First Line	:	610 MURPHY RD STE 109
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-5926
Country	:	US
Telephone Number	:	281-969-5221
Fax Number	:	281-377-3455

Provider Business Practice Location Address
First Line	:	5716 BELLAIRE BLVD STE J
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5512
Country	:	US
Telephone Number	:	281-969-5221
Fax Number	:	281-969-5048

Authorized Official
Title or Position	:	OWNER
Name	:	LUZ A MATEUS
Credential	:
Telephone Number	:	832-633-8219

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	07/20/2021

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Directions to “LAKEVIEW PHARMACY LLC ” Practice Location

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