NPIMap

Organization Active NPI

Washington State Dept of Social and Health Services

  • Long Term Care Pharmacy
  • Medical Lake, WA
National Provider Identifier
1457414138
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
PHAR.CF.00000468 Issued in WA
Legal business name
WASHINGTON STATE DEPT OF SOCIAL AND HEALTH SERVICES
Practice address
S 2320 Salnave Road
Medical Lake, WA 99022-0200
Phone
(509) 299-1948
Fax
(509) 299-1967
NPI assigned
Dec 18, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Carmen Joy Berg, RPHNPI 1902281959
Title
Clinical Pharmacist Supervisor
Phone
(509) 299-1948

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X PHAR.CF.00000468 WA Primary

Addresses

Primary practice location

S 2320 Salnave Road
Medical Lake, WA 99022-0200

Mailing address

PO Box 200
S 2320 Salnave Road
Medical Lake, WA 99022-0200
Phone (509) 299-1948

Other identifiers 1

IdentifierTypeStateIssuer
4904795OtherWANCPDP

Other names 1

  • Lakeland Village Pharmacy Other name

National Provider Directory

National Provider Directory
Tax ID family
Lynden School District16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1457414138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200",
            "address_2": "S 2320 SALNAVE ROAD",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220200",
            "telephone_number": "509-299-1948",
            "fax_number": "509-299-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S 2320 SALNAVE ROAD",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220200",
            "telephone_number": "509-299-1948",
            "fax_number": "509-299-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON STATE DEPT OF SOCIAL AND HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "CARMEN",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "CLINICAL PHARMACIST SUPERVISOR",
        "authorized_official_telephone_number": "509-299-1948",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.00000468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4904795",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeland Village Pharmacy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Medical Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.