Individual
MRS. PEARL A LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2214 S 57TH ST, PHILADELPHIA, PA 19143-5705
(886) 884-8807
(215) 825-5161
Mailing address
2250 E MONMOUTH ST, PHILADELPHIA, PA 19134-4103
(267) 884-8807
(215) 825-5161
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
7000.000000634RMA
PA
171000000X
Military Health Care Provider
70000634RMA
PA
Other
Enumeration date
12/12/2020
Last updated
12/12/2020
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