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Organization

BIG LAKE PHARMACY INC

Active
Other names
BIG LAKE PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
STEVEN NELSON RPH/CPH (CEO/PRES)
(863) 634-4002
Entity
Organization

Contact information

Practice address
203 SW PARK ST, STE B, OKEECHOBEE, FL 34972-4160
(863) 763-1339
(863) 763-1487
Mailing address
203 SW PARK ST, STE B, OKEECHOBEE, FL 34972-4160
(863) 763-1339
(863) 763-1487

Taxonomy

Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
3336L0003X
Long Term Care Pharmacy
Primary
PH18708
FL
3336M0003X
Managed Care Organization Pharmacy

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
031557500
FL
01
1096785
NCPDP PROVIDER IDENTIFICATION NUMBER
Enumeration date
01/18/2006
Last updated
10/09/2009
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