Organization
LAKE PHARMACY LLC
Active
Other names
Lake Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GOLDEN (OWNER)
(334) 569-2112
Entity
Organization
Contact information
Practice address
95 LIGHTWOOD RD, MAIN ST SLAPOUT, DEATSVILLE, AL 36022-3494
(334) 569-2112
(334) 569-1143
Mailing address
95 LIGHTWOOD RD, MAIN ST SLAPOUT, DEATSVILLE, AL 36022-3494
(334) 569-2112
(334) 569-1143
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
105942
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001378
—
AL
01
—
2151251
PK
—
Enumeration date
01/11/2007
Last updated
02/28/2017
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