Dales Southlake Pharmacy
LBN: Lake Of Decatur Inc
Dales Southlake Pharmacy is an health care organization with primary practice located at 245 W 1St Dr Ste B , Decatur IL 62521-5381. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Long Term Care Pharmacy, Suppliers / Managed Care Organization Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Lake Of Decatur Inc can be contacted via phone (217) 429-5165, or through Colee, Dale via phone (217) 429-5165.
Contact Information
Primary practice address
245 W 1St Dr Ste B
Decatur IL 62521-5381
Phone: (217) 429-5165
Fax: (217) 429-5172
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 54.015385 | Illinois |
| Suppliers / Long Term Care Pharmacy | 3336L0003X | ||
| Suppliers / Managed Care Organization Pharmacy | 3336M0003X |
Profile Details
| NPI number | 1588613384 |
|---|---|
| LBN Legal business name | Lake Of Decatur Inc |
| DBA Doing business as | Dales Southlake Pharmacy |
| Authorized official | Colee, Dale |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 9th, 2006 |
| Last updated | Oct 21st, 2021 - about 3 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588613384 | NPPES |
| Other | 2021672 | PK |
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