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Organization
LAKE PHARMACY
Active
Organization
LAKE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ARNOLD GEORGE FONG PHARM. D. (OWNER)
(510) 832-1804
Entity
Organization
Contact information
Practice address
287 13TH ST, OAKLAND, CA 94612-3900
(510) 832-1804
(510) 891-9278
Mailing address
287 13TH ST, OAKLAND, CA 94612-3900
(510) 832-1804
(510) 891-9278
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
27533
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0547426
NABP
CA
01
—
MEDI-CAL
PHA368610
CA
Enumeration date
04/13/2007
Last updated
03/07/2023
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