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General NPI Number Information
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NPI Number | 1275986531
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Entity Type | Organization
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Legal Business Name | CEDAR LAKE PHARMACY
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 917 DIVISION ST STE B
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City | BILOXI
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State | MS
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Zip | 39530-3001
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Country | US
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Telephone | 228-280-8931
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Fax | 228-280-8915
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Provider Business Mailing Address
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Address Line | 921 CEDAR LAKE RD STE F
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City | BILOXI
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State | MS
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Zip | 39532-2126
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Country | US
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Telephone | 228-280-8931
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Fax | 228-280-8915
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Authorized Official
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Title or Position | MANAGER
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Name | HANG NGUYEN
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Credential | PHARMD
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Telephone | 228-276-9009
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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 |
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License Number State |
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