| NPI | 1023374063 |
|---|---|
| Doing Business As | EAGLE LAKE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | POLYCARP AGBARA Owner 863-738-8002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PH25608) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2016-11-23 |