Lake Travis Pharmacy Partners LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

28908 Issued in TX

Legal business name

LAKE TRAVIS PHARMACY PARTNERS LLC

Practice address

12005 Bee Cave Pkwy Ste 1a
Austin, TX 78738-6387

Phone

(512) 608-9355

NPI assigned

Dec 6, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce McAnally

Title

Owner

Phone

(214) 734-8878

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Lake Hills Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Tax ID family

Lake Hills Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Lake Travis Pharmacy Partners

  • Long Term Care Pharmacy
  • Austin, TX
  • NPI 1750778783
  NPD tax ID
• Lake Travis Pharmacy Partners LLC

  • Long Term Care Pharmacy
  • Bee Cave, TX
  • NPI 1033743844
  NPD tax ID
• Lake Travis Pharmacy Partners, LLC

  • Pharmacy
  • Austin, TX
  • NPI 1669803151
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386288000000",
    "number": "1285065870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12005 BEE CAVE RD",
            "address_2": "SUITE 1A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78738",
            "telephone_number": "512-608-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12005 BEE CAVE PKWY STE 1A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787386387",
            "telephone_number": "512-608-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE TRAVIS PHARMACY PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2013-12-06",
        "status": "A",
        "authorized_official_last_name": "MCANALLY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-734-8878"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "28908",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2143234",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Hills Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Elizabeth Maxwell Lake, MSC
• Janet L Lake, RD, LD
• Marion Elizabeth Lake, PT
• Natalie Jane Lake, C.P.M., L.M.

• Pharmacy in Austin, TX
• Providers in Austin, TX by specialty
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.