Organization
LAKER DRUG INC.
Active
Other names
laker drug
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY D CARNES (PRESIDENT)
(270) 343-2336
Entity
Organization
Contact information
Practice address
92 JOE T PETTY DR, RUSSELL SPRINGS, KY 42642-8543
(270) 866-7787
Mailing address
92 JOE T PETTY DR, RUSSELL SPRINGS, KY 42642-8543
(270) 866-7787
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
P06839
KY
3336C0003X
Community/Retail Pharmacy
Primary
P06839
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54004593
—
KY
05
—
90009507
—
KY
Enumeration date
08/13/2006
Last updated
03/17/2008
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