Provider Demographics
NPI:1962716209
Name:EKANEY, LAWRENCE METUGE (PD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:METUGE
Last Name:EKANEY
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17826 DAVENPORT RD STE B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5876
Mailing Address - Country:US
Mailing Address - Phone:469-351-3462
Mailing Address - Fax:
Practice Address - Street 1:17826 DAVENPORT RD STE B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5876
Practice Address - Country:US
Practice Address - Phone:972-467-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist