Provider Demographics
NPI:1548683972
Name:LC PHARMA OF UVALDE LLC
Entity type:Organization
Organization Name:LC PHARMA OF UVALDE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:V
Authorized Official - Last Name:GOKARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-677-2626
Mailing Address - Street 1:1001 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-4831
Mailing Address - Country:US
Mailing Address - Phone:830-591-1000
Mailing Address - Fax:830-469-4506
Practice Address - Street 1:1001 E MAIN ST
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4831
Practice Address - Country:US
Practice Address - Phone:830-591-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX288833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28883OtherSTATE BOARD OF PHARMACY