Provider Demographics
NPI:1295532026
Name:THE LAKES ON 41 LLC
Entity type:Organization
Organization Name:THE LAKES ON 41 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOBRIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-234-6610
Mailing Address - Street 1:103 FLAGSHIP DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-5409
Mailing Address - Country:US
Mailing Address - Phone:813-776-1277
Mailing Address - Fax:813-776-1551
Practice Address - Street 1:103 FLAGSHIP DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-5409
Practice Address - Country:US
Practice Address - Phone:813-776-1277
Practice Address - Fax:813-776-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy