Silver Lake Pharmacy, LLC.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH27348 Issued in FL

Legal business name

SILVER LAKE PHARMACY, LLC.

Practice address

32729 Radio Rd
Leesburg, FL 34788-3900

Phone

(352) 217-0487

NPI assigned

Jan 8, 2014

Organization subpart

No

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

Authorized official

Name

Kamlesh Patel

Title

Pharmacy Manager

Phone

(352) 217-0487

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• SILVER LAKE PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1389139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403049600000",
    "number": "1376965566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 COTTON CT",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327262078",
            "telephone_number": "352-217-0487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32729 RADIO RD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347883900",
            "telephone_number": "352-217-0487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVER LAKE PHARMACY, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-08",
        "last_updated": "2014-06-18",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "KAMLESH",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "352-217-0487"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH27348",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010760900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SILVER LAKE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephen Joseph Signore, PA-C
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• John D Sikkema, DC
• Silent Syche
• Silver Lake Pediatrics, PA
• Silver Lake Village, Inc
• Linda L Silverman, PSYD
• Cristina P Simmons, MSOT, OTR/L
• Joshua Simmons, RBT
• Robert S Simon, OD

• All providers in Leesburg, FL
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; 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.