Provider Demographics
NPI:1659668275
Name:LAKELAND DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:LAKELAND DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRUNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-937-9715
Mailing Address - Street 1:1755 E EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3411
Mailing Address - Country:US
Mailing Address - Phone:863-937-9715
Mailing Address - Fax:863-937-9717
Practice Address - Street 1:1755 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3411
Practice Address - Country:US
Practice Address - Phone:863-937-9715
Practice Address - Fax:863-937-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS419193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy