Provider Demographics
NPI:1568848026
Name:LAKELAND FAMILY PHARMACY
Entity Type:Organization
Organization Name:LAKELAND FAMILY PHARMACY
Other - Org Name:LAKELAND FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-619-5269
Mailing Address - Street 1:3655 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4106
Mailing Address - Country:US
Mailing Address - Phone:863-644-5415
Mailing Address - Fax:863-644-2915
Practice Address - Street 1:3655 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4106
Practice Address - Country:US
Practice Address - Phone:863-644-5415
Practice Address - Fax:863-644-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH291463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153464OtherPK