| NPI | 1831608108 |
|---|---|
| Doing Business As | LAKE O RX |
| Entity Type | Organization |
| Authorized Contact | ANDREA CUSACK Owner/Pharmacist 877-855-9777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301011266) |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2022-07-21 |