Angus Lake Healthcare, LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PHRE009911 Issued in GA

Legal business name

ANGUS LAKE HEALTHCARE, LLC

Practice address

242 Milledgeville Hwy
Gordon, GA 31031-3827

Phone

(229) 520-5151

Fax

(478) 628-2263

NPI assigned

Apr 10, 2013

Last updated

May 4, 2017By 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

Carl Lake Stanley Jr., RPH

Title

Member

Phone

(229) 520-5151

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493856000000",
    "number": "1912340829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "GORDON",
            "state": "GA",
            "postal_code": "310310249",
            "telephone_number": "229-520-5151",
            "fax_number": "478-628-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 MILLEDGEVILLE HWY",
            "city": "GORDON",
            "state": "GA",
            "postal_code": "310313827",
            "telephone_number": "229-520-5151",
            "fax_number": "478-628-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGUS LAKE HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-10",
        "last_updated": "2017-05-04",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "LAKE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "229-520-5151",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "PHRE009911",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "GA",
            "license": "PHRE009911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Long Term Care Pharmacy in Gordon, GA
• Providers in Gordon, GA by specialty
• Long Term Care Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2017; 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.