Lake June Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LAKE JUNE PHARMACY LLC

Practice address

11203 Lake June Rd Ste 106
Balch Springs, TX 75180-1219

Phone

(614) 599-5576

NPI assigned

Dec 3, 2019

Organization subpart

No

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

Authorized official

Name

Issifu TeniiNPI 1770042772

Title

Manager

Phone

(614) 599-5576

Specialties & licenses 1

Addresses

Other names 1

• LAKE JUNE PHARMACY Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Issifu Tenii

  • Community/Retail Pharmacy
  • Balch Springs, TX
  • NPI 1770042772
  NPD Authorized official

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

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1366089815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11203 LAKE JUNE RD STE 106",
            "city": "BALCH SPRINGS",
            "state": "TX",
            "postal_code": "751801219",
            "telephone_number": "614-599-5576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11203 LAKE JUNE RD STE 106",
            "city": "BALCH SPRINGS",
            "state": "TX",
            "postal_code": "751801219",
            "telephone_number": "614-599-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE JUNE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-03",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "TENII",
        "authorized_official_first_name": "ISSIFU",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "614-599-5576"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE JUNE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LAKE JUNE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mohammed Tariq Khan, PHARMD
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• Sean C Kilgore, D.C., RN
• Kroger Texas L P
• Oluremi Ladeji
• Johnny Lewis, PSY.D
• Dorothy Chestine Marshall, M.D, M.P.H
• Martin Luther King, Jr. Family Clinic
• Brenda Medina
• Michael D. Fulton, D.O., P.a.

• Community/Retail Pharmacy in Balch Springs, TX
• Providers in Balch Springs, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.