| NPI | 1700194800 |
|---|---|
| Doing Business As | SOUTH LAKE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | HECTOR A MEDRANO Owner Managing Member 813-395-5667 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: FL PH24899) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2022-07-21 |