Provider Demographics
NPI:1558540583
Name:LEXANN PHARMACY INC
Entity Type:Organization
Organization Name:LEXANN PHARMACY INC
Other - Org Name:LEXANN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:408-806-6168
Mailing Address - Street 1:1569 LEXANN AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1794
Mailing Address - Country:US
Mailing Address - Phone:408-528-9079
Mailing Address - Fax:408-528-9070
Practice Address - Street 1:1569 LEXANN AVE
Practice Address - Street 2:STE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1794
Practice Address - Country:US
Practice Address - Phone:408-528-9079
Practice Address - Fax:408-528-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2112966OtherPK