Provider Demographics
NPI:1053301994
Name:LAKES, RICHARD B (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:LAKES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 CARROLL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KESWICK
Mailing Address - State:VA
Mailing Address - Zip Code:22947-9156
Mailing Address - Country:US
Mailing Address - Phone:434-984-6238
Mailing Address - Fax:434-984-6240
Practice Address - Street 1:3336 CARROLL CREEK RD
Practice Address - Street 2:
Practice Address - City:KESWICK
Practice Address - State:VA
Practice Address - Zip Code:22947-9155
Practice Address - Country:US
Practice Address - Phone:434-244-4301
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02004156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist