| Organization Name: | OCEAN LAKES PHARMACY INC |
| NPI Number: | 1316020589 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROGER WILLIAMS (OWNER) |
| Mailing Address: | 1415 Hwy 17 Business N Surfside Beach |
| State: | SC US |
| Postal Code: | 29575 |
| Phone Number: | 8432385159 |
| Fax Number: | 8432385150 |
| NPI Enumeration Date: | 10/23/2006 |
| NPI Last Update Date: | 10/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 50004721 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | SC |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |