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General NPI Number Information
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NPI Number | 1538397799
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Entity Type | Organization
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Legal Business Name | LAKE BRANDT PHARMACY, INC
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 1007 NC HIGHWAY 150 W STE E
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City | SUMMERFIELD
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State | NC
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Zip | 27358-7925
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Country | US
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Telephone | 336-643-2550
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Fax | 336-643-2115
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Provider Business Mailing Address
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Address Line | 1007 NC HIGHWAY 150 W STE E
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City | SUMMERFIELD
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State | NC
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Zip | 27358-7925
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Country | US
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Telephone | 336-643-2550
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Fax | 336-643-2115
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MONICA SPARKS BENFIELD
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Credential | R.PH.
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Telephone | 336-643-2550
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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 | 09907
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License Number State | NC
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