Provider Demographics
NPI:1265499453
Name:LAKEVIEW CENTER INC
Entity Type:Organization
Organization Name:LAKEVIEW CENTER INC
Other - Org Name:LAKEVIEW CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-469-3719
Mailing Address - Street 1:1201 W HERNANDEZ ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1815
Mailing Address - Country:US
Mailing Address - Phone:850-469-3719
Mailing Address - Fax:850-595-1412
Practice Address - Street 1:1201 W HERNANDEZ ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1815
Practice Address - Country:US
Practice Address - Phone:850-469-3719
Practice Address - Fax:850-595-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH60843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031722500Medicaid
2010017OtherPK