Provider Demographics
NPI:1679599526
Name:LAKE ONE COMMUNITY PHARMACY INC
Entity type:Organization
Organization Name:LAKE ONE COMMUNITY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHCY MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-433-3330
Mailing Address - Street 1:4849 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3461
Mailing Address - Country:US
Mailing Address - Phone:561-433-3330
Mailing Address - Fax:561-296-7310
Practice Address - Street 1:4849 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3461
Practice Address - Country:US
Practice Address - Phone:561-433-3330
Practice Address - Fax:561-296-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH218043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2006404OtherPK
2006404OtherPK