Individual
CODIE ALLEN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
301 PARKWAY PLZ, BARBOURVILLE, KY 40906-7429
(606) 546-5477
Mailing address
7468 KY 1304, GIRDLER, KY 40943-6406
(606) 622-9923
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
024622
KY
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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