Provider Demographics
NPI:1851508477
Name:LAX LLC
Entity Type:Organization
Organization Name:LAX LLC
Other - Org Name:LANCASTER PHARMACY & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-286-6262
Mailing Address - Street 1:108 N WOODLAND DR STE C
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-4779
Mailing Address - Country:US
Mailing Address - Phone:803-286-6262
Mailing Address - Fax:803-286-0002
Practice Address - Street 1:751 HWY 9 BYPASS W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4779
Practice Address - Country:US
Practice Address - Phone:803-286-6262
Practice Address - Fax:803-286-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
SC137643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134380OtherPK
SC5014570001Medicare NSC