Lake Odessa Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301011266 Issued in MI

Legal business name

LAKE ODESSA PHARMACY

Practice address

802 4TH Ave
Lake Odessa, MI 48849-1002

Phone

(877) 855-9777

Fax

(877) 855-8222

NPI assigned

Sep 29, 2017

Organization subpart

No

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

Authorized official

Name

Andrea CusackNPI 1255617585

Title

Owner/Pharmacist

Phone

(877) 855-9777

Specialties & licenses 1

Addresses

Other names 1

• Lake O Rx Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Andrea R Cusack

  • Pharmacist
  • Lake Odessa, MI
  • NPI 1255617585
  NPD Authorized official

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

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1831608108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 4TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491002",
            "telephone_number": "877-855-9777",
            "fax_number": "877-855-8222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 4TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491002",
            "telephone_number": "877-855-9777",
            "fax_number": "877-855-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE ODESSA PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-29",
        "last_updated": "2022-07-21",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "CUSACK",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "877-855-9777"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301011266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake O Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chad Ronald Hickey, D.C.
• Jordan Christian Counseling
• Linda L. Kimmel, MA, LPC
• Kathryn Kutas
• Lake Odessa Dental, PLLC
• Lansing Ophthalmology, PC
• Laurie S Braker MD PLC
• Gerald T Licari, DDS
• Lo Optical, LLC
• Luminate Home Care, LLC

• Community/Retail Pharmacy in Lake Odessa, MI
• Providers in Lake Odessa, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.