Lake Village Drugstore, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

LAKE VILLAGE DRUGSTORE, INC.

Practice address

2907 Hwy 65-82 South
Lake Village, AR 71653

Phone

(870) 265-5555

Fax

(870) 265-3174

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Kamila Lea Crouse, PHARM. D.NPI 1396563748

Title

Pharmacy Manager/Pharmacist in Char

Phone

(870) 265-5555

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

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

• Kamila Lea Crouse, PHARM .D.

  • Pharmacist
  • Lake Village, AR
  • NPI 1396563748
  NPD Authorized official

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1487789400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 548",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716530548",
            "telephone_number": "870-265-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2907 HWY 65-82 SOUTH",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "71653",
            "telephone_number": "870-265-5555",
            "fax_number": "870-265-3174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE VILLAGE DRUGSTORE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "CROUSE",
        "authorized_official_first_name": "KAMILA",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "PHARMACY MANAGER/PHARMACIST IN CHAR",
        "authorized_official_telephone_number": "870-265-5555",
        "authorized_official_credential": "PHARM. D."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "0403890",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100517407",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Johnson, PTA
• Stephanie Jones
• Jskmf, LLC
• Lab One LLC
• Lake Village Clinic PA
• Lake Village Healthcare Center, LLC
• Lake Village Operations LLC
• Lakeside Public Schools
• Toma Renea Lee, LPE-I
• Brandi Lewis

• All providers in Lake Village, AR
• Community/Retail Pharmacy in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.