Active NPI
Garry Patrick Lake, RPH
- Pharmacist
- San Angelo, TX
National Provider Identifier
1669021127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22885
- Practice address
- 3440 S Bryant Blvd
San Angelo, TX 76903-9308 - Phone
- (325) 276-6598
- Fax
- (325) 276-6597
- NPI assigned
- Sep 8, 2019
- Last updated
- Sep 8, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 22885 | TX | Primary |
Addresses
Primary practice location
3440 S Bryant Blvd
San Angelo, TX 76903-9308
Mailing address
3440 S Bryant Blvd
San Angelo, TX 76903-9308
Phone (325) 276-6598
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22885 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567900800000",
"number": "1669021127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3440 S BRYANT BLVD",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769039308",
"telephone_number": "325-276-6598",
"fax_number": "325-276-6597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3440 S BRYANT BLVD",
"city": "SAN ANGELO",
"state": "TX",
"postal_code": "769039308",
"telephone_number": "325-276-6598",
"fax_number": "325-276-6597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAKE",
"first_name": "GARRY",
"middle_name": "PATRICK",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-08",
"last_updated": "2019-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "22885",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Angelo, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.