| Organization Name: | LAKE KATRINE VILLAGE APOTHECARY LLC |
| NPI Number: | 1740609395 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NEAL ROBERT SMOLLER (OWNER) |
| Mailing Address: | 1561 Ulster Avenue Lake Katrine |
| State: | NY US |
| Postal Code: | 12449 |
| Phone Number: | 8455217455 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2014 |
| NPI Last Update Date: | 02/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |