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General NPI Number Information
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NPI Number | 1215477419
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Entity Type | Organization
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Legal Business Name | BEAR LAKE PHARMACY, LLC
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 3840 E SEMORAN BLVD SUITE 1048
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City | APOPKA
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State | FL
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Zip | 32703-6197
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Country | US
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Telephone | 407-848-4442
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Fax | 321-444-6731
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Provider Business Mailing Address
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Address Line | 3840 E SEMORAN BLVD SUITE 1048
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City | APOPKA
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State | FL
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Zip | 32703-6197
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Country | US
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Telephone | 407-848-4442
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Fax | 321-444-6731
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Authorized Official
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Title or Position | OWNER
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Name | DR. WALTER L SEIFERT
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Credential | M.D.
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Telephone | 407-848-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 151690
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License Number State | FL
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