| NPI | 1508164351 |
|---|---|
| Doing Business As | LAKE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | MAHESH L PATEL Owner 904-786-3005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2013-03-12 |