Organization
LAKE TOWN PHARMACY LLC
Active
Other names
Benzer pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RAJASEKARAN MANI (OWNER, AO, PHCY MANAGER, PIC)
(239) 246-0796
Entity
Organization
Contact information
Practice address
2020 CR N 470 UNIT B, LAKE PANASOFFKEE, FL 33538
(352) 444-2055
(352) 569-4768
Mailing address
2020 CR N 470 UNIT B, LAKE PANASOFFKEE, FL 33538
(352) 444-2055
(352) 569-4768
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH28934
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016675400
—
FL
01
—
2154679
PK
—
Enumeration date
10/09/2015
Last updated
09/24/2021
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