Individual
BRIAN P LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM D
Contact information
Practice address
1305 W UNIVERSITY BLVD, ODESSA, TX 79764-7121
(432) 580-0166
Mailing address
1305 W UNIVERSITY BLVD, ODESSA, TX 79764-7121
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
47511
TX
Other
Enumeration date
12/02/2009
Last updated
12/02/2009
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