Organization
LAKE COUNTRY HEALTHCARE LLC
Active
Other names
LAKE COUNTRY HEALTHCARE LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARSENA MCINTOSH (MANAGER)
(918) 457-5535
Entity
Organization
Contact information
Practice address
27753 S WELLING RD, WELLING, OK 74471-2202
(918) 457-9997
(918) 457-5096
Mailing address
27753 S WELLING RD, WELLING, OK 74471-2202
(918) 457-9997
(918) 457-5096
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
365591
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200008180A
—
OK
01
—
3723625
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/30/2006
Last updated
12/16/2011
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