Provider Demographics
NPI:1558465518
Name:LAVA SERVICES INC
Entity Type:Organization
Organization Name:LAVA SERVICES INC
Other - Org Name:STRAWBERRY FAMILY DRUG & PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVALLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-740-9033
Mailing Address - Street 1:1802 STRAWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-2621
Mailing Address - Country:US
Mailing Address - Phone:713-740-9033
Mailing Address - Fax:713-740-9044
Practice Address - Street 1:1802 STRAWBERRY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-2621
Practice Address - Country:US
Practice Address - Phone:713-740-9033
Practice Address - Fax:713-740-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
TX215443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145174Medicaid
2090523OtherPK
TX4742200001Medicare NSC