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General NPI Number Information
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NPI Number | 1235272568
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Entity Type | Organization
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Legal Business Name | CENTRAL LAKE PHARMACY INC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 2424 N MAIN STREET
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City | CENTRAL LAKE
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State | MI
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Zip | 49622-0425
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Country | US
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Telephone | 231-544-2929
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Fax | 231-544-5408
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Provider Business Mailing Address
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Address Line | PO BOX 425
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City | CENTRAL LAKE
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State | MI
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Zip | 49622-0425
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Country | US
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Telephone | 231-544-2929
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Fax | 231-544-5408
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DUANE LYLE CHAPPUIES
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Credential | RPH
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Telephone | 231-536-7657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301005744
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License Number State | MI
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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 | 5301005744
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License Number State | MI
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