Provider Demographics
NPI:1679666028
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:
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
Mailing Address - Street 2:STE 550
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2965
Mailing Address - Country:US
Mailing Address - Phone:512-442-6777
Mailing Address - Fax:512-442-0555
Practice Address - Street 1:1509 S LAMAR BLVD
Practice Address - Street 2:STE 550
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2965
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:2006-09-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 332B00000X, 333600000X, 3336C0004X, 3336S0011X
TX263833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119683OtherPK
TX145689Medicaid
2119683OtherPK