Healthcare Provider Details

I. General information

NPI: 1730611419
Provider Name (Legal Business Name): LAKEVICK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 S EASTON RD
DOYLESTOWN PA
18901-7103
US

IV. Provider business mailing address

50 KULP RD E
CHALFONT PA
18914-3729
US

V. Phone/Fax

Practice location:
  • Phone: 267-640-6733
  • Fax: 267-483-8795
Mailing address:
  • Phone: 267-640-6733
  • Fax: 267-483-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPI000001
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOS007466L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberOS007466L
License Number StatePA

VIII. Authorized Official

Name: MR. JAMES H VICKERY
Title or Position: OWNER/PHARMACIST
Credential: R. PH.
Phone: 215-348-9711