Provider Demographics
NPI:1811924756
Name:LAKELAND DRUG CO
Entity type:Organization
Organization Name:LAKELAND DRUG CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-482-3677
Mailing Address - Street 1:42 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-6835
Mailing Address - Country:US
Mailing Address - Phone:229-482-3677
Mailing Address - Fax:229-482-2072
Practice Address - Street 1:42 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-6835
Practice Address - Country:US
Practice Address - Phone:229-482-3677
Practice Address - Fax:229-482-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GAPHRE0032713336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136987OtherPK
GA000030456BMedicaid