Dadeville Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

DADEVILLE PHARMACY LLC

Doing business as

Lakeshore Pharmacy

Practice address

221 E South St
Dadeville, AL 36853-1923

Phone

(256) 825-0063

Fax

(256) 825-5584

NPI assigned

Dec 17, 2018

Last updated

Nov 3, 2022By 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

Joe A Dalton, RPH

Title

Owner

Phone

(334) 797-7992

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeshore Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Tax ID family

Dadeville Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Dadeville Pharmacy LLC

  dba Lakeshore Discount Pharmacy

  • Pharmacy
  • Dadeville, AL
  • NPI 1932967908
  NPD tax ID

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.

• Krystal Cummings, PHARMD

  • Pharmacist
  • Dadeville, AL
  • NPI 1942841416
  NPD

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1366914202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 279",
            "city": "SLOCOMB",
            "state": "AL",
            "postal_code": "363750279",
            "telephone_number": "334-797-7992",
            "fax_number": "256-825-5584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 E SOUTH ST",
            "city": "DADEVILLE",
            "state": "AL",
            "postal_code": "368531923",
            "telephone_number": "256-825-0063",
            "fax_number": "256-825-5584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DADEVILLE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2022-11-03",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "DALTON",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-797-7992",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226751",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeshore Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carolyn Chatmon, LRD
• James Lee Clanton, R.PH.
• Debbie S Cleveland, CRNP
• Krystal Cummings, PHARMD
• Dadeville Healthcare Center LLC
• Dadeville Pharmacy LLC (Lakeshore Discount Pharmacy)
• Dadeville RX, LLC
• Brian Heath Daniel
• Laura R Daniel, CRNP
• Sabrina Colley Davis, CRNP

• Community/Retail Pharmacy in Dadeville, AL
• Providers in Dadeville, AL by specialty
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.