Organization
BTB LAKEWAY INC
Active
Other names
LAKEWAY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENNETT T BROOKE RPH (PRESIDENT)
(512) 261-6567
Entity
Organization
Contact information
Practice address
1202 LAKEWAY DR, LAKEWAY, TX 78734-4473
(512) 261-6567
(512) 261-6017
Mailing address
1202 LAKEWAY DR, LAKEWAY, TX 78734-4473
(512) 261-6567
(512) 261-6017
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
15354
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0684839
—
TX
Enumeration date
12/12/2006
Last updated
08/22/2020
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