MEDICARE: LELA 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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1922601822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LELA PHARMACY LLC

Provider Business Mailing Address
First Line	:	1713 SW MILITARY DR STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1430
Country	:	US
Telephone Number	:	210-348-1532
Fax Number	:	726-999-8053

Provider Business Practice Location Address
First Line	:	1713 SW MILITARY DR STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1430
Country	:	US
Telephone Number	:	210-348-1532
Fax Number	:	726-999-8053

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	GILBERT GITAU
Credential	:	PHARMD
Telephone Number	:	210-348-1532

Provider Enumeration Date	:	11/21/2020
Last Update Date	:	02/28/2023

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Directions to “LELA PHARMACY LLC ” Practice Location

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