OrganizationActive
Angus Lake Healthcare, LLC
NPI 1912340829 · Long Term Care Pharmacy · Gordon, GA
Provider details
- NPI number
- 1912340829
- Entity type
- Organization
- Primary specialty
- Long Term Care PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Carl Stanley, Member(229) 520-5151
- License
- PHRE009911 (GA)
Specialties & taxonomies
Suppliers
Suppliers
Practice location
242 Milledgeville Hwy
Gordon, GA 31031-3827
Phone: (229) 520-5151
Fax: (478) 628-2263
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 249
Gordon, GA 31031-0249
Registry dates
- Enumerated
- 2013-04-10
- Last updated
- 2017-05-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.