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General NPI Number Information
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NPI Number | 1295532026
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Entity Type | Organization
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Legal Business Name | THE LAKES ON 41 LLC
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 103 FLAGSHIP DR
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City | LUTZ
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State | FL
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Zip | 33549-5409
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Country | US
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Telephone | 813-776-1277
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Fax | 813-776-1551
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Provider Business Mailing Address
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Address Line | 103 FLAGSHIP DR
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City | LUTZ
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State | FL
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Zip | 33549-5409
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Country | US
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Telephone | 813-776-1277
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Fax | 813-776-1551
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | SANDRA GHOBRIAL
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Credential |
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Telephone | 714-234-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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