Provider Demographics
NPI:1962492801
Name:LAKES, ALICE H (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:H
Last Name:LAKES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ALICE
Other - Middle Name:H
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
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 1:3337 CARROLL CREEK RD
Practice Address - Street 2:
Practice Address - City:KESWICK
Practice Address - State:VA
Practice Address - Zip Code:22947-9156
Practice Address - Country:US
Practice Address - Phone:434-984-6238
Practice Address - Fax:434-984-6240
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
VA02004315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist