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Contact Information

EAGLE LAKE PHARMACY INC
5245 A U S HWY 98 N
SUITE A
LAKELAND, FL33809
 Phone: 863-937-7992
 Fax: 863-937-7994
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for EAGLE LAKE PHARMACY INC

NPI # 1023374063
LBN Legal business name EAGLE LAKE PHARMACY INC
Authorized official POLYCARP AGBARA - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 04/04/2012
Last updated 11/23/2016 - About 10 years ago
Identifiers
FL License # PH25608
FL Medicaid 004712900
Other 2134900 PK
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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