Provider Demographics
NPI:1992219877
Name:LEADWAY GROUP LLC
Entity Type:Organization
Organization Name:LEADWAY GROUP LLC
Other - Org Name:LEADWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:OYEJIDE
Authorized Official - Middle Name:JULIUS
Authorized Official - Last Name:ADEWOYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:832-664-8713
Mailing Address - Street 1:9370 W SAM HOUSTON PKWY S STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-5224
Mailing Address - Country:US
Mailing Address - Phone:832-664-8713
Mailing Address - Fax:
Practice Address - Street 1:9370 W SAM HOUSTON PKWY S STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5224
Practice Address - Country:US
Practice Address - Phone:832-664-8713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317233336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy