Clearbrook Lodge Inc

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

PHAR.CF.60295845 Issued in WA

Legal business name

CLEARBROOK LODGE INC

Doing business as

Northwoods Lodge Pharmacy

Practice address

2321 NW Schold PL
Silverdale, WA 98383-9504

Phone

(360) 698-3930

Fax

(360) 307-9562

NPI assigned

Jun 21, 2005

Last updated

Jun 19, 2014By 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

David Smith

Title

RX Manager

Phone

(360) 698-3930

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• NORTHWOODS LODGE PHARMACY Doing business as

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1770589129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 NW SCHOLD PL",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839504",
            "telephone_number": "360-698-3930",
            "fax_number": "360-307-9562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 NW SCHOLD PL",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839504",
            "telephone_number": "360-698-3930",
            "fax_number": "360-307-9562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEARBROOK LODGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "RX MANAGER",
        "authorized_official_telephone_number": "360-698-3930"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WA",
            "license": "PHAR.CF.60295845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2110559",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWOODS LODGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Drew Gabriel Clark, DC
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• Tiffin Clegg, MD
• Gina McCann Cleveland
• Kevin Scott Clive, M.D.
• Laura Kathryn Cobb, PA-C
• Jesse Cobell, MD

• Long Term Care Pharmacy in Silverdale, WA
• Providers in Silverdale, WA by specialty
• Long Term Care Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.