| NPI | 1912201906 |
|---|---|
| Doing Business As | LAKE CUMBERLAND PHARMACY #2 |
| Entity Type | Organization |
| Authorized Contact | JONATHAN GRIDER Managing Member 270-858-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KY P07440) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition |
| 333600000X Pharmacy | |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2022-10-07 |