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Lakewood Health System

Organization Active NPI Community/Retail Pharmacy · Staples, MN

NPI 1679347348 · NPPES record last updated Jun 9, 2025

Key facts

NPI
1679347348
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
Legal business name
LAKEWOOD HEALTH SYSTEM
Practice address
1210 US Highway 10 E
Suite 1
Staples, MN 56479
Phone
(218) 894-2242
Fax
(218) 894-2013
NPI assigned
Nov 13, 2023
Organization subpart
Yes
Parent organization (as reported)
LAKEWOOD HEALTH SYSTEM

Authorized official

Name
Joseph Reycraft
Title
Cfo
Phone
(218) 894-8194

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 13

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

Practitioners 107

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

View all 107

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MN

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakewood Clinic
Staples, MN · CCN 243422		 Rural health clinic 5% Or Greater Direct Ownership Interest
General Partnership Interest		 Apr 1, 1997
Apr 1, 1997
Lakewood Clinic-Browerville
Eagle Bend, MN · CCN 243421		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1997
Lakewood Clinic-Pillager
Pillager, MN · CCN 243436		 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Mar 1, 1998
Mar 1, 1998

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20231219001032 MN DME Supplier - Pharmacy 1052229671 Practice locations: Staples, MN
O20231228001019 MN Part B Supplier - Pharmacy 1052229671 2 other NPIs on this enrollment
Practice locations: Pillager, MN; Staples, MN

National Provider Directory

Tax ID family
Lakewood Clinic Staples (14 organizations share this tax ID)
Part of
Lakewood Clinic Staples

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Yes
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

1210 US Highway 10 E
Suite 1
Staples, MN 56479

Mailing address

49725 County 83
Staples, MN 56479-5280
Phone (218) 894-1515

Other identifiers

IdentifierTypeStateIssuer
266844OtherMNSTATE PHARMACY LICENSE

Other names

  • Longbella Drug by Lakewood Health System - Plaza Doing business as

Other providers in Staples, MN

All providers in Staples, MN · Community/Retail Pharmacy in Minnesota

Sources for this page

Verify at the official NPI Registry.