Organization
LAKE WIRE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHORETTE BENNETT DICKENS R PH PHARM D (PHARMACY MANAGER)
(863) 682-6880
Entity
Organization
Contact information
Practice address
505 MARTIN LUTHER KING JR AVE, SUITE 3, LAKELAND, FL 33815
(863) 682-6880
(863) 688-0721
Mailing address
505 MARTIN LUTHER KING JR AVE, SUITE 3, LAKELAND, FL 33815
(863) 682-6880
(863) 688-0721
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PS18682
FL
333600000X
Pharmacy
Primary
PH10343
FL
Other
Enumeration date
01/02/2007
Last updated
09/11/2025
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