Individual
CARL LAKE STANLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH, CDM
Contact information
Practice address
240 MILLEDGEVILLE HWY, GORDON, GA 31031-3827
(478) 628-2425
(478) 628-2263
Mailing address
PO BOX 249, GORDON, GA 31031-0249
(478) 628-2425
(478) 628-2263
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10890
GA
Other
Enumeration date
07/24/2006
Last updated
01/28/2010
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