Provider Demographics
NPI:1407960487
Name:LK PHARMACY INC
Entity Type:Organization
Organization Name:LK PHARMACY INC
Other - Org Name:LINCOLN KNOLLS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-744-3337
Mailing Address - Street 1:819 MCCARTNEY RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-5047
Mailing Address - Country:US
Mailing Address - Phone:330-744-3337
Mailing Address - Fax:330-744-5588
Practice Address - Street 1:819 MCCARTNEY RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-5047
Practice Address - Country:US
Practice Address - Phone:330-744-3337
Practice Address - Fax:330-744-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021434500333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2456640Medicaid
3670735OtherOTHER ID NUMBER-COMMERCIAL NUMBER