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General NPI Number Information
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NPI Number | 1487789400
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Entity Type | Organization
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Legal Business Name | LAKE VILLAGE DRUGSTORE, INC.
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 2907 HWY 65-82 SOUTH
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City | LAKE VILLAGE
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State | AR
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Zip | 71653
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Country | US
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Telephone | 870-265-5555
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Fax | 870-265-3174
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Provider Business Mailing Address
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Address Line | PO BOX 548
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City | LAKE VILLAGE
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State | AR
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Zip | 71653-0548
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Country | US
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Telephone | 870-265-5555
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER/PHARMACIST IN CHAR
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Name | KAMILA LEA CROUSE
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Credential | PHARM. D.
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Telephone | 870-265-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0403890
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License Number State | AR
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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 |
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License Number State |
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