| Organization Name: | LAKE OF DECATUR, INC |
| NPI Number: | 1265863468 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DALE COLEE (OWNER) |
| Mailing Address: | 845 S Route 51 Unit B Forsyth |
| State: | IL US |
| Postal Code: | 625359759 |
| Phone Number: | 2173309552 |
| Fax Number: | 2177916280 |
| NPI Enumeration Date: | 12/12/2013 |
| NPI Last Update Date: | 12/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0003X |
| License Number: | 054-018441 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Community/Retail Pharmacy |
| Taxonomy Definition: | 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. |