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General NPI Number Information
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NPI Number | 1376965566
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Entity Type | Organization
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Legal Business Name | SILVER LAKE PHARMACY, LLC.
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Dates
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Enumeration Date | 01/08/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 32729 RADIO RD
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City | LEESBURG
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State | FL
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Zip | 34788-3900
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Country | US
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Telephone | 352-217-0487
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 COTTON CT
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City | EUSTIS
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State | FL
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Zip | 32726-2078
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Country | US
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Telephone | 352-217-0487
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | KAMLESH PATEL
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Credential |
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Telephone | 352-217-0487
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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 | PH27348
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License Number State | FL
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