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Organization
COMPOUNDING SPECIALISTS AT LAKE OCONEE INC
Active
Organization
COMPOUNDING SPECIALISTS AT LAKE OCONEE INC
Active
Other names
Lake Country Pharmacy & Compounding Center
Organization subpart
No
Provider details
NPI number
Authorized official
CAREY VAUGHAN PHARMD (CEO)
(706) 923-2933
Entity
Organization
Contact information
Practice address
1110 COMMERCE DR STE 110, GREENSBORO, GA 30642-7444
(706) 923-2933
(706) 923-2930
Mailing address
1110 COMMERCE DR STE 110, GREENSBORO, GA 30642-7444
(706) 923-2933
(706) 923-2930
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009902
GA
3336C0004X
Compounding Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Enumeration date
12/24/2007
Last updated
02/20/2017
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