Provider Demographics
NPI:1457664914
Name:LBJ ENTERPRISES, INC
Entity Type:Organization
Organization Name:LBJ ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-239-6700
Mailing Address - Street 1:210 JACKS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-1619
Mailing Address - Country:US
Mailing Address - Phone:270-239-6700
Mailing Address - Fax:270-239-6701
Practice Address - Street 1:210 JACKS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-1619
Practice Address - Country:US
Practice Address - Phone:270-239-6700
Practice Address - Fax:270-239-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP073983336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy