Lake of Decatur Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054.020012 Issued in IL

Legal business name

LAKE OF DECATUR INC

Practice address

320 E Central Ave
Decatur, IL 62521-4665

Phone

(217) 330-5004

NPI assigned

Jul 6, 2016

Organization subpart

No

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

Authorized official

Name

Dale Colee

Title

President

Phone

(217) 429-5165

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Colee's Community Pharmacy Doing business as

Tax ID family

Colee'S Community Pharmacy2 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.

• Lake of Decatur, Inc

  • Community/Retail Pharmacy
  • Forsyth, IL
  • NPI 1265863468
  NPD tax ID

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634688000000",
    "number": "1386096170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 E CENTRAL AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214665",
            "telephone_number": "217-330-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 E CENTRAL AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625214665",
            "telephone_number": "217-330-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE OF DECATUR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A",
        "authorized_official_last_name": "COLEE",
        "authorized_official_first_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-429-5165"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054.020012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160891",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colee's Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sneha Kumar, MD
• Kristen Kwasniak
• Don Michael Kyle Sr., P.T.
• Steven J Lafleur
• Kristin Lafollette, RPH
• Lake of Decatur Inc
• Lake Shore OB GYN of Decatur S C
• Hannah Lamb, LPC
• Karen Lamb, P.T.
• Katy J Lambert, LCSW

• Community/Retail Pharmacy in Decatur, IL
• Providers in Decatur, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; 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.