LAKE CITY PHARMACY (2948)    INSTITUTION (4)

Name Value
NAME LAKE CITY PHARMACY
STATE FLORIDA
STREET ADDR. 1 619 SOUTH MARION AVE
CITY LAKE CITY
ZIP 32025-5808
OFFICIAL VA NAME Lake City Pharmacy
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME LAKE CITY VAMC PHARMACY
ST. ADDR. 1 (MAILING) 619 SOUTH MARION AVE
CITY (MAILING) Lake City
STATE (MAILING) FLORIDA
ZIP (MAILING) 32025-5808
EFFECTIVE DATE/TIME
  • 2006-08-22 00:00:00
    STATUS:   ACTIVE
    NPI:   1972551323
TAXONOMY CODE
  • Suppliers
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1972551323