Lark Rexall Drugs Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY 51871 Issued in CA

Legal business name

LARK REXALL DRUGS INC

Doing business as

Lark Drugs Pharmacy

Practice address

16251 Main St
Guerneville, CA 95446-8300

Phone

(707) 869-9055

Fax

(707) 869-9203

NPI assigned

Sep 6, 2006

Last updated

Mar 25, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Amalia Nicola, PHARMACY TECH

Title

President/Owner

Phone

(707) 869-9055

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• LARK DRUGS PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Sebastopol Family Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Sebastopol, CA
  • NPI 1457858565

  Member Of

  NPD member

Practitioners 5

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.

• Ann Blancke

  • Pharmacist
  • Guerneville, CA
  • NPI 1285024166
  NPD (past)
• Nicole Lauren Heeney, PHARMD

  • Pharmacotherapy Pharmacist
  • Santa Rosa, CA
  • NPI 1407331937
  NPD (past)
• Thomas Gerard Male, PHARMD

  • Pharmacist
  • Guerneville, CA
  • NPI 1437754868
  NPD (past)
• Christopher Arthur Newell, PHARM. D.

  • Pharmacist
  • Guerneville, CA
  • NPI 1326461187
  NPD (past)
• Maria Vodovoz, PHARMD

  • Pharmacist
  • Sebastopol, CA
  • NPI 1003768839
  NPD (past)

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427241600000",
    "number": "1750484820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16251 MAIN ST",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "954468300",
            "telephone_number": "707-869-9055",
            "fax_number": "707-869-9203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16251 MAIN ST",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "954468300",
            "telephone_number": "707-869-9055",
            "fax_number": "707-869-9203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARK REXALL DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2015-03-25",
        "status": "A",
        "authorized_official_last_name": "NICOLA",
        "authorized_official_first_name": "AMALIA",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "707-869-9055",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PHARMACY TECH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CA",
            "license": "PHY 51871",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY 51871",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE BOARD OF PHARMACY LICENSE",
            "identifier": "PHY 51871",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE (IMMUNIZATIONS)",
            "identifier": "135347",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER NUMNER",
            "identifier": "1750484820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LARK DRUGS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christopher Nevin Johnston
• Charles Andrew Kennedy, ASW
• Paige Nicole Kline, PPSC
• Walter Krampf, MD
• Roger J Kuhn, PHD
• Susan Maria Lavelle, NP
• Gregery K Lester, DC
• Debrah Elissa Lyons
• Thomas Gerard Male, PHARMD
• Michael Martin, AS

• Community/Retail Pharmacy in Guerneville, CA
• Providers in Guerneville, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.