Provider Demographics
NPI:1912144353
Name:K & M LAKE PLACID INC
Entity Type:Organization
Organization Name:K & M LAKE PLACID INC
Other - Org Name:K & M DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KARMEN
Authorized Official - Last Name:MUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:863-517-1142
Mailing Address - Street 1:133 TOWER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-6836
Mailing Address - Country:US
Mailing Address - Phone:863-260-0100
Mailing Address - Fax:863-260-0164
Practice Address - Street 1:133 TOWER ST
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-6836
Practice Address - Country:US
Practice Address - Phone:863-260-0100
Practice Address - Fax:863-260-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH238173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000688300Medicaid
FL000688301Medicaid
FL6376230001Medicare NSC