Lake Wire Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

PH10343 Issued in FL

Legal business name

LAKE WIRE PHARMACY INC

Practice address

505 Martin Luther King Jr Ave
Suite 3
Lakeland, FL 33815

Phone

(863) 682-6880

Fax

(863) 688-0721

NPI assigned

Jan 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Chorette Bennett Dickens, R PH PHARM D

Title

Pharmacy Manager

Phone

(863) 682-6880

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1104983899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 MARTIN LUTHER KING JR AVE",
            "address_2": "SUITE 3",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33815",
            "telephone_number": "863-682-6880",
            "fax_number": "863-688-0721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 MARTIN LUTHER KING JR AVE",
            "address_2": "SUITE 3",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33815",
            "telephone_number": "863-682-6880",
            "fax_number": "863-688-0721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WIRE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "DICKENS",
        "authorized_official_first_name": "CHORETTE",
        "authorized_official_middle_name": "BENNETT",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "863-682-6880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "R PH PHARM D"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS18682",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "FL",
            "license": "PH10343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.