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General NPI Number Information
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NPI Number | 1003661356
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Entity Type | Organization
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Legal Business Name | LAKEN PHARMACY LLC
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Dates
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Enumeration Date | 04/20/2024
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Last Update Date | 04/20/2024
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Provider Practice Location Address
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Address Line | 4560 TAMIAMI TRL STE 5
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2954
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Country | US
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Telephone | 941-535-2020
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Fax | 941-353-2010
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Provider Business Mailing Address
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Address Line | 3470 17TH ST
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City | SARASOTA
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State | FL
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Zip | 34235-8906
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Country | US
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Telephone | 941-955-7700
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Fax | 941-955-0800
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. ELDER EUCLIDES SORIA-FERRAS
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Credential | RPH
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Telephone | 941-544-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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