1730611419 NPI number — LAKEVICK LLC

Table of content: (NPI 1730611419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730611419 NPI number — LAKEVICK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVICK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730611419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 KULP RD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHALFONT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18914-3729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-640-6733
Provider Business Mailing Address Fax Number:
267-483-8795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1980 S EASTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18901-7103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-640-6733
Provider Business Practice Location Address Fax Number:
267-483-8795
Provider Enumeration Date:
03/31/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VICKERY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER/PHARMACIST
Authorized Official Telephone Number:
215-348-9711

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  OS007466L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: RPI000001 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: OS007466L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)