| NPI | 1063855211 |
|---|---|
| Doing Business As | ANGUS LAKE VITAL CARE |
| Entity Type | Organization |
| Authorized Contact | CARL LAKE STANLEY Member 478-387-2399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA PHHH000055) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition (Licence: GA PHHH000055) |
| 3336C0004X Pharmacy, Compounding Pharmacy (Licence: GA PHHH000055) | |
| 3336H0001X Pharmacy, Home Infusion Therapy Pharmacy (Licence: GA PHHH000055) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2013-10-18 |