# ANGUS LAKE HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912340829
- **Authorized official:** CARL LAKE STANLEY JR. RPH (MEMBER)
- **Authorized official phone:** (229) 520-5151

## Contact information

- **Practice address:** 242 MILLEDGEVILLE HWY, GORDON, GA 31031-3827
- **Practice address phone:** (229) 520-5151
- **Practice address fax:** (478) 628-2263
- **Mailing address:** PO BOX 249, GORDON, GA 31031-0249
- **Mailing address phone:** (229) 520-5151
- **Mailing address fax:** (478) 628-2263

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | PHRE009911 | GA | — |
| 3336L0003X | Long Term Care Pharmacy | PHRE009911 | GA | Yes |

## Other

- **Enumeration date:** 04/10/2013
- **Last updated:** 05/04/2017