| NPI | 1326605452 |
|---|---|
| Doing Business As | LAKE COUNTRY COMPOUNDING & WELLNESS |
| Entity Type | Organization |
| Authorized Contact | CAREY A. VAUGHAN Owner 762-777-7001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2021-01-20 |