Angus Lake Healthcare, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE008912 Issued in GA

Legal business name

ANGUS LAKE HEALTHCARE, LLC

Doing business as

Gordon Compounding Pharmacy

Practice address

240 Milledgeville Hwy # a
Gordon, GA 31031-3827

Phone

(478) 628-2425

Fax

(478) 628-2263

NPI assigned

Sep 13, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carla Sappe, PHARMDNPI 1366468522

Title

Pharmacist in Charge

Phone

(478) 628-2425

Specialties & licenses 1

Addresses

Other names 1

• Gordon Compounding Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carla Stanley Sappe, PHARMD, CDM

  • Pharmacist
  • Gordon, GA
  • NPI 1366468522
  Authorized official Same address or phone

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275637787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "address_2": "240A MILLEDGEVILLE ROAD",
            "city": "GORDON",
            "state": "GA",
            "postal_code": "310310249",
            "telephone_number": "478-628-2425",
            "fax_number": "478-628-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MILLEDGEVILLE HWY # A",
            "city": "GORDON",
            "state": "GA",
            "postal_code": "310313827",
            "telephone_number": "478-628-2425",
            "fax_number": "478-628-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGUS LAKE HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SAPPE",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "478-628-2425",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE008912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gordon Compounding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angus Lake Healthcare, LLC
• Angus Lake Infusion Services (Angus Lake Vital Care)
• Bless to the Max, Inc. (Bless Child R3 Oasis)
• Community Health Care Systems, Inc (Community Health Care Systems-Wilkinson)
• Dennis R. Smith DDS, Inc.

• Community/Retail Pharmacy in Gordon, GA
• Providers in Gordon, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.