Lake Health Services

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY55420 Issued in CA

Legal business name

LAKE HEALTH SERVICES

Practice address

15230 Lakeshore Dr
Clearlake, CA 95422

Phone

(707) 994-3141

Fax

(707) 994-7150

NPI assigned

Jun 30, 2005

Organization subpart

Yes

Parent organization

LAKE HEALTH SERVICESAs reported in NPPES

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

Authorized official

Name

Tim Nguyen, PHARMD

Title

President

Phone

(925) 586-2112

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Lake Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Tax ID family

Lake Health Services Inc3 organizations share this tax ID, including this one

Part of

Lake Health Services Inc

Other organizations with this tax ID 2

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

• Lake Health Services, Inc.

  • Long Term Care Pharmacy
  • Clearlake, CA
  • NPI 1043071962
  NPD tax ID
• Lake Health Services, Inc.

  • Community/Retail Pharmacy
  • Hidden Valley Lake, CA
  • NPI 1710584388
  NPD tax ID

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588291200000",
    "number": "1770580268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6376",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954227150",
            "telephone_number": "707-994-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "95422",
            "telephone_number": "707-994-3141",
            "fax_number": "707-994-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKE HEALTH SERVICES",
        "enumeration_date": "2005-06-30",
        "last_updated": "2020-05-01",
        "certification_date": "2020-05-01",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-586-2112",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY55420",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2001004",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA471230",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lake County Office of Education
• Lake County Office of Education
• Lake County Office of Education
• Lake County Tribal Health Consortium, Inc.
• Lake County Tribal Health Southshore Clinic
• Lake Health Services, Inc.
• Lake Silverado Cardiovascular Consultants
• Lakeshore Fire Prot District
• Tiffany Sue Lambert
• Adriana Kasandra Landa

• Community/Retail Pharmacy in Clearlake, CA
• Providers in Clearlake, 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 May 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.