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General NPI Number Information
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NPI Number | 1952407215
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Entity Type | Organization
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Legal Business Name | LAKE MARTIN PHARMACY
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 301 MARIARDEN RD SUITE A
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City | DADEVILLE
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State | AL
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Zip | 36853-6254
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Country | US
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Telephone | 256-825-7822
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Fax | 256-827-0802
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Provider Business Mailing Address
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Address Line | 301 MARIARDEN RD SUITE A
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City | DADEVILLE
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State | AL
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Zip | 36853-6254
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Country | US
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Telephone | 256-825-7822
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Fax | 256-827-0802
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Authorized Official
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Title or Position | PHARMACY MANAGER/OWNER
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Name | DR. LEE RANDAL MCDONALD
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Credential | PHARM D
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Telephone | 256-825-7822
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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 | 112856
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License Number State | AL
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