Provider Demographics
NPI:1588180095
Name:LAKEPOINTE PHARMACY INC
Entity Type:Organization
Organization Name:LAKEPOINTE PHARMACY INC
Other - Org Name:LAKEPOINTE PHARMACY #1
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHUONGTRINH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-722-4339
Mailing Address - Street 1:1005 W RALPH HALL PKWY
Mailing Address - Street 2:STE 147
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6658
Mailing Address - Country:US
Mailing Address - Phone:972-722-4339
Mailing Address - Fax:888-737-4524
Practice Address - Street 1:1005 W RALPH HALL PKWY
Practice Address - Street 2:STE 147
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6658
Practice Address - Country:US
Practice Address - Phone:972-722-4339
Practice Address - Fax:888-737-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX261933336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145951Medicaid
2170617OtherPK