NPI | 1801211826 |
---|---|
Doing Business As | LAKESHORE FAMILY MEDICINE DERBY |
Entity Type | Organization |
Authorized Contact | KENNY HEINE VP Of Operations 858-964-1506 |
Organization Subpart ? | Yes |
Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NY 233142) |
Enumeration Date | 2014-02-27 |
Last Update Date | 2014-02-27 |