Provider Demographics
NPI:1184672941
Name:LANCASTER VA CMOP
Entity Type:Organization
Organization Name:LANCASTER VA CMOP
Other - Org Name:US DEPT OF VETERANS AFFAIRS
Other - Org Type:Other Name
Authorized Official - Title/Position:NATIONAL CMOP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-758-4701
Mailing Address - Street 1:2962 S LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-2118
Mailing Address - Country:US
Mailing Address - Phone:972-228-6230
Mailing Address - Fax:
Practice Address - Street 1:2962 S LONGHORN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2118
Practice Address - Country:US
Practice Address - Phone:972-228-6230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4538976OtherNCPDP#
TX4538976OtherNCPDP#