EAGLE LAKE PHARMACY INC (NPI# 1023374063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023374063 |
| Entity Type | Organization |
| Organization Name | EAGLE LAKE PHARMACY INC |
| Other Organization Name | EAGLE LAKE PHARMACY |
| Practice Address |
5245 A U S Hwy 98 N Suite A Lakeland FL 33809 |
| Practice Telephone | 8639377992 |
| Practice Fax Number | 8639377994 |
| Mailing Telephone | 8639377992 |
| Mailing Fax Number | 8639377994 |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2016-11-23 |
| Authorized Official Name | POLYCARP AGBARA (OWNER) |
| Authorized Official Telephone | 8637388002 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PH25608 | FL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2134900 | 01 | |
| FL | 004712900 | 05 |
| Other Name | Type Code |
|---|---|
| Eagle Lake Pharmacy | Doing Business As Name - Organization |
| Street Address |
5245 A U S HWY 98 N SUITE A |
| City | LAKELAND |
| State | FL |
| Zip Code | 33809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861018178 | John C Gallik | Military Health Care Provider | 3176 Corporal Johnson Road, Jbsa Fort Sam Houston, TX 33809 | 2020-06-23 |
| 1376189209 | Julie Independence Tomchak | Nurse's Aide | 7805 Us Highway Lot 29 # 98 N, Lakeland, FL 33809 | 2019-11-26 |
| 1912465923 | Lakeland Oaks Nh LLC | Skilled Nursing Facility | 855 Carpenters Way, Lakeland, FL 33809 | 2019-03-08 |
| 1235528753 | Christia Mccann | Physician Assistant | 4120 Us Hwy. 98 N., One Lakeland Square, Lakeland, FL 33809 | 2015-01-21 |
| 1548679616 | Ashley Frances Hamarowicz | Physical Therapist | 771 Carpenters Way, Lakeland, FL 33809 | 2014-08-04 |
| 1750700860 | Grace Manor Suites | Assisted Living Facility | 4620 N Socrum Loop Road, Lakeland, FL 33809 | 2014-04-16 |
| 1164769980 | Christopher Fisher | Hearing Instrument Specialist | 3800 North Rd 98, Ste 500, Lakeland, FL 33809 | 2013-01-14 |
| 1851669675 | Reginald Keith Jenkins | Pharmacist | 1043 Walt Williams Road, Lakeland, FL 33809 | 2011-12-07 |
| 1578859633 | Jill Margaret Waldrop | Pharmacist | 6600 N. Socrum Loop, Lakeland, FL 33809 | 2011-06-27 |
| 1154598555 | Mission Health & Massage Inc. | Massage Therapist | 930 Marcum Road Suite 5, Lakeland, FL 33809 | 2008-05-14 |
| Find all providers in zip 33809 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073147849 | Baycare Urgent Care, LLC | Pharmacy | 2645 S Florida Ave, Lakeland, FL 33803-3829 | 2020-03-02 |
| 1003370057 | Riaan Pharmacy LLC | Pharmacy | 2105 New Tampa Hwy, Lakeland, FL 33815-7364 | 2019-01-24 |
| 1902298805 | Us Specialty Care, LLC | Pharmacy | 500 Eagles Landing Dr Ste A, Lakeland, FL 33810-2899 | 2015-03-02 |
| 1326447988 | Lakeland Family Pharmacy | Pharmacy | 605 W Memorial Blvd, Lakeland, FL 33815-1466 | 2014-08-20 |
| 1659668275 | Lakeland Discount Pharmacy | Pharmacy | 1755 E Edgewood Dr, Lakeland, FL 33803-3411 | 2011-07-03 |
| 1760779615 | Med Express Rx | Pharmacy | 1717 Shepherd Rd, Lakeland, FL 33811-2179 | 2011-06-29 |
| 1255405775 | Tri-county Human Services Inc | Pharmacy | 1807 Crystal Lake Dr, Lakeland, FL 33801-5979 | 2006-11-17 |
| 1104911072 | Publix Super Markets, Inc. | Pharmacy | 3300 Publix Corporate Pkwy, Lakeland, FL 33811-3311 | 2006-10-04 |
| 1891899878 | Holiday Cvs LLC | Pharmacy | 101 N Wabash Ave, Lakeland, FL 33815-7368 | 2006-09-12 |
| 1174627061 | Holiday Cvs LLC | Pharmacy | 5010 S Florida Ave, Lakeland, FL 33813-2510 | 2006-09-12 |
| Find all providers in LAKELAND | ||||
Please comment or provide details below to improve the information on EAGLE LAKE PHARMACY INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.