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General NPI Number Information
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NPI Number | 1851320931
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Entity Type | Organization
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Legal Business Name | LAKESHORE PHARMACY INC.
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 51 W LAKESHORE DR
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City | BURNSIDE
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State | KY
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Zip | 42519-9424
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Country | US
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Telephone | 606-561-7104
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Fax | 606-561-9205
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Provider Business Mailing Address
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Address Line | 51 W LAKESHORE DR
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City | BURNSIDE
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State | KY
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Zip | 42519-9424
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Country | US
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Telephone | 606-561-7104
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Fax | 606-561-9205
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATTY GREGORY GUINN
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Credential | PHARM.D.
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Telephone | 606-561-7104
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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 | P06673
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | P06673
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P06673
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License Number State | KY
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