Provider Demographics
NPI:1366065468
Name:LEXINGTON PHARMACY LLC
Entity type:Organization
Organization Name:LEXINGTON PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:DHRUTIBEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:806-831-7107
Mailing Address - Street 1:104 SCARBOROUGH DR STE C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-1922
Mailing Address - Country:US
Mailing Address - Phone:803-490-0022
Mailing Address - Fax:803-490-0029
Practice Address - Street 1:104 SCARBOROUGH DR STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-1922
Practice Address - Country:US
Practice Address - Phone:803-490-0022
Practice Address - Fax:803-490-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7Z1101Medicaid