| Organization Name: | LBJ ENTERPRISES, INC. |
| NPI Number: | 1114911526 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURA P SPENCER (PHARMACIST OWNER) |
| Mailing Address: | 210 Jacks Shopping Ctr Scottsville |
| State: | KY US |
| Postal Code: | 421641619 |
| Phone Number: | 2702396700 |
| Fax Number: | 2702396701 |
| NPI Enumeration Date: | 08/31/2005 |
| NPI Last Update Date: | 06/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | PO 7398 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |