Individual
DR. AMANDA JOY LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
219 GLENVILLE DR, FORT MILL, SC 29715-5815
(803) 802-4424
(803) 802-4432
Mailing address
219 GLENVILLE DR, FORT MILL, SC 29715-5815
(803) 802-4424
(803) 802-4432
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10534
SC
Other
Enumeration date
02/02/2011
Last updated
02/02/2011
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