Organization
LAKEWAY PHARMACY LLC
Active
Other names
Lakeway Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
IHEANACHO EZIRIM (PHARMACIST IN CHARGE)
(409) 504-2962
Entity
Organization
Contact information
Practice address
3500 RANCH ROAD 620 S, SUITE A-100, BEE CAVE, TX 78738-7153
(512) 502-5161
(512) 502-5227
Mailing address
3500 RANCH ROAD 620 S, SUITE A-100, BEE CAVE, TX 78738-7153
(512) 502-5161
(512) 502-5227
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
32003
TX
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177383
PK
—
Enumeration date
04/30/2018
Last updated
04/30/2018
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