Individual
MR. JUSTIN WILLIAM LAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
2700 W FRYE RD, CHANDLER, AZ 85224-4950
(888) 694-7287
Mailing address
3717 E MORNING STAR LN, GILBERT, AZ 85298-4822
(480) 634-5906
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0202011748
VA
183500000X
Pharmacist
Primary
S014383
AZ
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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