Lake Park Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE008870 Issued in GA

Legal business name

LAKE PARK PHARMACY LLC

Practice address

453 Lakes Blvd
Lake Park, GA 31636-6607

Phone

(229) 559-9394

Fax

(229) 559-9408

NPI assigned

Sep 21, 2006

Organization subpart

No

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

Authorized official

Name

Hugh Chancy, RPH

Title

Owner

Phone

(229) 794-3525

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• CHANCY DRUGS Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wendy Ann Dorminey, PHARM D CDM

  • Pharmacist
  • Lake Park, GA
  • NPI 1235222415
  NPD (past)

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1508964537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "453 LAKES BLVD",
            "city": "LAKE PARK",
            "state": "GA",
            "postal_code": "316366607",
            "telephone_number": "229-559-9394",
            "fax_number": "229-559-9408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 LAKES BLVD",
            "city": "LAKE PARK",
            "state": "GA",
            "postal_code": "316366607",
            "telephone_number": "229-559-9394",
            "fax_number": "229-559-9408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PARK PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "CHANCY",
        "authorized_official_first_name": "HUGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-794-3525",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE008870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2015653",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008211566B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHANCY DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Lake Park, GA
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.