Lake Escape Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

NC05919 Issued in NC

Legal business name

LAKE ESCAPE INC

Doing business as

MEDICAP PHARMACY

Practice address

378 W Harden St
Burlington, NC 27215-7516

Phone

(336) 222-9811

Fax

(336) 222-9310

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

P David David Smith, RPH

Title

President

Phone

(336) 222-9811

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• MEDICAP PHARMACY Doing business as

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225843200000",
    "number": "1124161864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1144",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272161144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "378 W HARDEN ST",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272157516",
            "telephone_number": "336-222-9811",
            "fax_number": "336-222-9310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ESCAPE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2008-11-05",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "P DAVID",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-222-9811",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "NC05919",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015701",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3431246",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAP PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laboratory Corporation of America Holdings
• Laboratory Corporation of America Holdings
• Michelle Jeanine Lacayo, PA-C
• Myla P Lai-Goldman, M.D.
• Lair Home Care Ventures LLC
• Lake Escape Inc
• Lakeview Professional Counseling, PLLC
• Sakeenah Lambert
• Edward D. Lance, M.D.
• Laura Fox Landon, CPNP-PC

• Community/Retail Pharmacy in Burlington, NC
• Providers in Burlington, NC by specialty
• Community/Retail Pharmacy in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; 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.