Provider Demographics
NPI:1659879997
Name:LAMAR PLAZA DRUG STORE LA&B, LLC
Entity Type:Organization
Organization Name:LAMAR PLAZA DRUG STORE LA&B, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, PHAMD
Authorized Official - Prefix:
Authorized Official - First Name:LYNH
Authorized Official - Middle Name:NGOC PHAM
Authorized Official - Last Name:WARNKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-442-6777
Mailing Address - Street 1:1509 S LAMAR BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2988
Mailing Address - Country:US
Mailing Address - Phone:512-442-6777
Mailing Address - Fax:512-442-0555
Practice Address - Street 1:1509 S LAMAR BLVD STE 550
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2988
Practice Address - Country:US
Practice Address - Phone:512-442-6777
Practice Address - Fax:512-442-0555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA&B PHARMACY PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-31
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263833336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145999Medicaid