Lake Country Pharmacy LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

Legal business name

LAKE COUNTRY PHARMACY LLC

Doing business as

Lake Country Compounding & Wellness

Practice address

121 Harmony Xing Ste 3
Eatonton, GA 31024-9573

Phone

(762) 777-7001

Fax

(762) 777-7002

NPI assigned

May 23, 2019

Last updated

Jan 20, 2021By 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

Dr. Carey A. Vaughan, PHARMDNPI 1073664942

Title

Owner

Phone

(762) 777-7001

Specialties & licenses 5

Addresses

Other names 1

• Lake Country Compounding & Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

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.

• Carey A. Vaughan, PHARMD

  • Pharmacist
  • Eatonton, GA
  • NPI 1073664942
  NPD Authorized official
• Christopher Alan Vaughan, PHARMD

  • Pharmacist
  • Eatonton, GA
  • NPI 1730428780
  NPD

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1326605452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 HARMONY XING STE 3",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310249573",
            "telephone_number": "762-777-7001",
            "fax_number": "762-777-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 HARMONY XING STE 3",
            "city": "EATONTON",
            "state": "GA",
            "postal_code": "310249573",
            "telephone_number": "762-777-7001",
            "fax_number": "762-777-7002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "CAREY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "762-777-7001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Country Compounding & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Whitney Knowlton, PA
• Ajay Kumar, M.D.
• Rakesh Kumar, MD
• Lake Country Family Chiropractic LLC
• Lake Country Language and Literacy LLC
• Lake Country Physical Therapy LLC
• Lake Oconee Medical Associates LLC
• Lake Oconee Partners in Healthcare, LLC
• Lake Oconee Pharmacy & Compounding Center
• Lake Oconee Rehabilitation and Performance Center, LLC

• Compounding Pharmacy in Eatonton, GA
• Providers in Eatonton, GA by specialty
• Compounding Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.