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General NPI Number Information
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NPI Number | 1952221459
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Entity Type | Individual
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Provider Name | PATRICK RYAN LAKE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2026
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Last Update Date | 07/16/2026
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Provider Practice Location Address
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Address Line | 30 PROSPECT AVE
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City | HACKENSACK
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State | NJ
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Zip | 07601-1915
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Country | US
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Telephone | 551-996-4282
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Fax |
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Provider Business Mailing Address
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Address Line | 58 ANDERSON DR
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City | CLIFTON
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State | NJ
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Zip | 07013-4226
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Country | US
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Telephone | 551-996-4282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835I0206X
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Taxonomy Name | Infectious Diseases Pharmacist
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License Number | 28RI03652500
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License Number State | NJ
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