Organization
LAKE VILLAGE DRUGSTORE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMILA LEA CROUSE PHARM. D. (PHARMACY MANAGER/PHARMACIST IN CHAR)
(870) 265-5555
Entity
Organization
Contact information
Practice address
2907 HWY 65-82 SOUTH, LAKE VILLAGE, AR 71653
(870) 265-5555
(870) 265-3174
Mailing address
PO BOX 548, LAKE VILLAGE, AR 71653-0548
(870) 265-5555
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
0403890
AR
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100517407
—
AR
Enumeration date
02/22/2007
Last updated
09/16/2022
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