Most Relevant Information
Provider Data
| NPI Number: | 1003196569 |
| Provider Name: | LANCE LAKE RPH |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 2001010937 |
Most Important Dates
| Enumeration Date: | 08/27/2011 |
| Last Updated: | 08/27/2011 |
Provider Practice Location
1675 W SOUTH ST
OZARK
MO
657215152
Practice Location Phone/Fax
| Phone: | 4174850762 |
| Fax: | 4174850793 |
Provider Mailing Location
1675 W SOUTH ST
OZARK
MO
657215152
Provider Mailing Phone/Fax
| Phone: | 4174850762 |
| Fax: | 4174850793 |