Organization
ANGUS LAKE HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL LAKE STANLEY JR. RPH (MEMBER)
(229) 520-5151
Entity
Organization
Contact information
Practice address
242 MILLEDGEVILLE HWY, GORDON, GA 31031-3827
(229) 520-5151
(478) 628-2263
Mailing address
PO BOX 249, GORDON, GA 31031-0249
(229) 520-5151
(478) 628-2263
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHRE009911
GA
3336L0003X
Long Term Care Pharmacy
Primary
PHRE009911
GA
Other
Enumeration date
04/10/2013
Last updated
05/04/2017
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