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General NPI Number Information
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NPI Number | 1497067276
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Entity Type | Organization
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Legal Business Name | LAKE CARMEL RX INC.
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 511 ROUTE 52
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City | CARMEL
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State | NY
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Zip | 10512-6064
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Country | US
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Telephone | 845-225-4242
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Fax | 845-225-9349
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Provider Business Mailing Address
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Address Line | 511 ROUTE 52
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City | CARMEL
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State | NY
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Zip | 10512-6064
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Country | US
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Telephone | 845-225-4242
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Fax | 845-225-9349
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Authorized Official
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Title or Position | PRESIDENT
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Name | SRINIVASA R. TALLA
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Credential |
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Telephone | 845-225-4242
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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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