Provider Demographics
NPI:1346884327
Name:PACKARD, LUAIN
Entity type:Individual
Prefix:
First Name:LUAIN
Middle Name:
Last Name:PACKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1443
Mailing Address - Country:US
Mailing Address - Phone:806-355-5029
Mailing Address - Fax:806-355-5288
Practice Address - Street 1:102 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-1443
Practice Address - Country:US
Practice Address - Phone:806-355-5029
Practice Address - Fax:806-355-5288
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist