Provider Demographics
NPI:1790287647
Name:LENEXA PHARMACY LLC
Entity Type:Organization
Organization Name:LENEXA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGONKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-423-0135
Mailing Address - Street 1:7209 NORTHERN LIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8990
Mailing Address - Country:US
Mailing Address - Phone:281-250-4134
Mailing Address - Fax:
Practice Address - Street 1:412 VILLAGE DR STE 100A
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4631
Practice Address - Country:US
Practice Address - Phone:972-423-0135
Practice Address - Fax:972-767-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy