NPIMap

Organization Active NPI

Lake Health Services, Inc.

  • Long Term Care Pharmacy
  • Clearlake, CA
National Provider Identifier
1043071962
Registry record updated Feb 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
LAKE HEALTH SERVICES, INC.
Practice address
15230 Lakeshore Dr
Clearlake, CA 95422-8107
Phone
(707) 994-3141
Fax
(707) 994-7150
NPI assigned
Jan 18, 2024
Organization subpart
Yes
Parent organization
LAKE HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tim Nguyen, PHARMD
Title
President
Phone
(707) 994-3141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

15230 Lakeshore Dr
Clearlake, CA 95422-8107

Mailing address

PO Box 7150
Clearlake, CA 95422-7150
Phone (707) 994-3141

Other names 1

  • Lake Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lake Health Services Inc3 organizations share this tax ID, including this one
Part of
Lake Health Services Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707004800000",
    "number": "1043071962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7150",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954227150",
            "telephone_number": "707-994-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "707-994-3141",
            "fax_number": "707-994-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE HEALTH SERVICES, INC.",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-02-04",
        "certification_date": "2024-02-04",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-994-3141",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clearlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.