1679666028 NPI number — LAMAR PLAZA DRUG STORE LA&B, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679666028 NPI number — LAMAR PLAZA DRUG STORE LA&B, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAMAR PLAZA DRUG STORE LA&B, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679666028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 S LAMAR BLVD
Provider Second Line Business Mailing Address:
STE 550
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-442-6777
Provider Business Mailing Address Fax Number:
512-442-0555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 S LAMAR BLVD
Provider Second Line Business Practice Location Address:
STE 550
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-442-6777
Provider Business Practice Location Address Fax Number:
512-442-0555
Provider Enumeration Date:
09/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARNKEN
Authorized Official First Name:
LYNH
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER, PHAMD
Authorized Official Telephone Number:
512-442-6777

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 26383 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2119683 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145689 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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