Lake Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH6551 Issued in FL

Legal business name

LAKE PHARMACY INC

Practice address

25 Martin Luther King Jr Blvd
Suite 3
Belle Glade, FL 33430-4044

Phone

(561) 996-0200

Fax

(561) 996-0201

NPI assigned

Oct 14, 2005

Organization subpart

No

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

Authorized official

Name

Robert Story, RPA

Title

Rpa

Phone

(561) 996-0200

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313625600000",
    "number": "1972592889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 977",
            "city": "BELLE GLADE",
            "state": "FL",
            "postal_code": "334300977",
            "telephone_number": "561-996-0200",
            "fax_number": "561-996-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MARTIN LUTHER KING JR BLVD",
            "address_2": "SUITE 3",
            "city": "BELLE GLADE",
            "state": "FL",
            "postal_code": "334304044",
            "telephone_number": "561-996-0200",
            "fax_number": "561-996-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2011-08-18",
        "status": "A",
        "authorized_official_last_name": "STORY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "RPA",
        "authorized_official_telephone_number": "561-996-0200",
        "authorized_official_credential": "RPA"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH6551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "1033884",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105213600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica Knight
• Stan K Kotei, RPH
• Hina Anjom Laeeq, PA
• Lake Express Pharmacy Inc
• Lake Medical Center PLLC
• Lakeshore Anesthesia, Inc.
• Lakeside Medical Center
• Mallory Lazell, DPT
• Wodwentzky Lefranc, MD
• Legacy Behavioral Health Center

• Community/Retail Pharmacy in Belle Glade, FL
• Providers in Belle Glade, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; 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.