Provider Demographics
NPI:1295314482
Name:LAVINGHOUSEZ, NANCY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:LAVINGHOUSEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4910 MUELLER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-628-1900
Mailing Address - Fax:
Practice Address - Street 1:4910 MUELLER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-628-1900
Practice Address - Fax:512-628-1901
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty