Organization
LYNN'S LA VEGA PHARMACY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADY LYNN EVERETT (PRESIDENT)
(254) 799-4949
Entity
Organization
Contact information
Practice address
2401 E WACO DR, WACO, TX 76705-3259
(254) 799-4949
Mailing address
2401 E WACO DR, WACO, TX 76705-3259
(254) 799-4949
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141863
—
TX
01
—
2096115
PK
—
Enumeration date
07/13/2018
Last updated
10/08/2018
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