Provider Demographics
NPI:1720357064
Name:RAYVAL, LLC
Entity Type:Organization
Organization Name:RAYVAL, LLC
Other - Org Name:LAKEPOINTE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAM
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-733-1033
Mailing Address - Street 1:2715 OSLER DR STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1051
Mailing Address - Country:US
Mailing Address - Phone:469-733-1033
Mailing Address - Fax:469-733-1034
Practice Address - Street 1:2715 OSLER DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1051
Practice Address - Country:US
Practice Address - Phone:469-733-1033
Practice Address - Fax:469-733-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X, 3336L0003X, 3336S0011X
TX293113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146520Medicaid
2133101OtherPK