NPIMap

Organization Active NPI

Southshore Tribal Health Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Clearlake, CA
National Provider Identifier
1376289322
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
SOUTHSHORE TRIBAL HEALTH PHARMACY
Practice address
14440 Olympic Drive
Suite B
Clearlake, CA 95422-9545
Phone
(707) 263-8382
Fax
(707) 263-5019
NPI assigned
May 11, 2022
Organization subpart
Yes
Parent organization
LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Mr. Thomas Burnett
Title
It Specialist
Phone
(707) 263-8382

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary

Addresses

Primary practice location

14440 Olympic Drive
Suite B
Clearlake, CA 95422-9545

Mailing address

925 Bevins CT
Lakeport, CA 95453-9754
Phone (707) 263-8382

National Provider Directory

National Provider Directory
Tax ID family
Southshore Tribal Health Pharmacy4 organizations share this tax ID, including this one
Part of
Southshore Tribal Health Pharmacy

Other organizations with this tax ID 3

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

Locations

14440 Olympic Dr
Ste B
Clearlake, CA 95422
Phone (707) 263-8382

NPI Registry JSON

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

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1376289322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 BEVINS CT",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954539754",
            "telephone_number": "707-263-8382",
            "fax_number": "707-263-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14440 OLYMPIC DRIVE",
            "address_2": "SUITE B",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954229545",
            "telephone_number": "707-263-8382",
            "fax_number": "707-263-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSHORE TRIBAL HEALTH PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC.",
        "enumeration_date": "2022-05-11",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "BURNETT",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "IT SPECIALIST",
        "authorized_official_telephone_number": "707-263-8382",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 7, 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.