1902910995 NPI number — LAMPASAS DRUG CO., LTD.

Table of content: (NPI 1902910995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902910995 NPI number — LAMPASAS DRUG CO., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAMPASAS DRUG CO., LTD.
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:
CATTLES PHARMACY
Provider Other Organization Name Type Code:
3
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:
1902910995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 N KEY AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAMPASAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76550-1843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-556-5141
Provider Business Mailing Address Fax Number:
512-556-5641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 N KEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAMPASAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76550-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-556-5141
Provider Business Practice Location Address Fax Number:
512-556-5641
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PARTNER/PHARMACIST
Authorized Official Telephone Number:
254-223-1262

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 566 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140624 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2092488 . This is a "PK" identifier . This identifiers is of the category "OTHER".