Provider Demographics
NPI:1295062966
Name:LAKA, WILLIAM S (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:LAKA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 N. FM 548
Mailing Address - Street 2:WALGREENS # 10817
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4034
Mailing Address - Country:US
Mailing Address - Phone:972-552-1633
Mailing Address - Fax:
Practice Address - Street 1:451 N. FM 548
Practice Address - Street 2:WALGREENS # 10817
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4034
Practice Address - Country:US
Practice Address - Phone:972-552-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist