Connor Trenton Lake, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

2024031293 Issued in MO

Practice address

3650 Stardust Dr
Hannibal, MO 63401-2411

Phone

(573) 406-0682

NPI assigned

Aug 7, 2024

Last updated

Jan 22, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1265263701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 STARDUST DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634012411",
            "telephone_number": "573-406-0682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 STARDUST DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634012411",
            "telephone_number": "573-406-0682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAKE",
        "first_name": "CONNOR",
        "middle_name": "TRENTON",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-07",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051306670",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "2024031293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ali Koerper, PHARMD
• Blake Kramer, D.O.
• Megan Kramer, D.O.
• Megan Elizabeth Kretz, MSN, FNP-BC
• Becky Kroeger, LPN
• Brittany R Lamont
• Jessica Lynn Lang, LMSW
• Rebecca Elizabeth Larson, PHARMD
• Shane Joseph Larue, MD
• Amanda R Lauby

• Pharmacist in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.