Provider Demographics
NPI:1730611419
Name:LAKEVICK LLC
Entity type:Organization
Organization Name:LAKEVICK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:215-348-9711
Mailing Address - Street 1:50 KULP RD E
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3729
Mailing Address - Country:US
Mailing Address - Phone:267-640-6733
Mailing Address - Fax:267-483-8795
Practice Address - Street 1:1980 S EASTON RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-7103
Practice Address - Country:US
Practice Address - Phone:267-640-6733
Practice Address - Fax:267-483-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007466L261QH0100X, 261Q00000X
PARPI000001183500000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty