Organization
LAKE ESCAPE INC
Active
Other names
MEDICAP PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
P DAVID DAVID SMITH RPH (PRESIDENT)
(336) 222-9811
Entity
Organization
Contact information
Practice address
378 W HARDEN ST, BURLINGTON, NC 27215-7516
(336) 222-9811
(336) 222-9310
Mailing address
PO BOX 1144, BURLINGTON, NC 27216-1144
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
NC05919
NC
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015701
—
NC
01
—
3431246
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/14/2007
Last updated
11/05/2008
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