Provider Demographics
NPI:1801340542
Name:PRAETORIAN RX LLC
Entity type:Organization
Organization Name:PRAETORIAN RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:813-279-2729
Mailing Address - Street 1:1880 S DAIRY ASHFORD RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4760
Mailing Address - Country:US
Mailing Address - Phone:813-279-2729
Mailing Address - Fax:813-279-2728
Practice Address - Street 1:1880 S DAIRY ASHFORD RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4760
Practice Address - Country:US
Practice Address - Phone:813-279-2729
Practice Address - Fax:813-279-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health