Organization
LAKE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT STORY RPA (RPA)
(561) 996-0200
Entity
Organization
Contact information
Practice address
25 MARTIN LUTHER KING JR BLVD, SUITE 3, BELLE GLADE, FL 33430-4044
(561) 996-0200
(561) 996-0201
Mailing address
PO BOX 977, BELLE GLADE, FL 33430-0977
(561) 996-0200
(561) 996-0201
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH6551
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033884
OTHER ID NUMBER
—
05
—
105213600
—
FL
Enumeration date
10/14/2005
Last updated
08/18/2011
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