MEDICARE: LAWRENCE METUGE EKANEY PD

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	183500000X	Pharmacist	51362	TX

General Provider Information

NPI Number	:	1962716209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE METUGE EKANEY PD

Provider Business Mailing Address
First Line	:	17826 DAVENPORT RD STE B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5876
Country	:	US
Telephone Number	:	469-351-3462
Fax Number	:

Provider Business Practice Location Address
First Line	:	17826 DAVENPORT RD STE B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5876
Country	:	US
Telephone Number	:	972-467-0173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	09/23/2020

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