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General NPI Number Information
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NPI Number | 1912144353
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Entity Type | Organization
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Legal Business Name | K & M LAKE PLACID INC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 133 TOWER ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-6836
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Country | US
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Telephone | 863-260-0100
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Fax | 863-260-0164
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Provider Business Mailing Address
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Address Line | 133 TOWER ST
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City | LAKE PLACID
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State | FL
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Zip | 33852-6836
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Country | US
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Telephone | 863-260-0100
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Fax | 863-260-0164
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOHN KARMEN MUNSON
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Credential | PHARMACIST
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Telephone | 863-517-1142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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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 | PH23817
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License Number State | FL
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