Organization
LAKE COUNTRY PHARMACY LLC
Active
Other names
Lake Country Compounding & Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAREY A. VAUGHAN PHARMD (OWNER)
(762) 777-7001
Entity
Organization
Contact information
Practice address
121 HARMONY XING STE 3, EATONTON, GA 31024-9573
(762) 777-7001
(762) 777-7002
Mailing address
121 HARMONY XING STE 3, EATONTON, GA 31024-9573
(762) 777-7001
(762) 777-7002
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Enumeration date
05/23/2019
Last updated
01/20/2021
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