Lakeland Pharmacy Berrien

Primary specialty

Institutional PharmacyTaxonomy code 3336I0012X

License

5301006978 Issued in MI

Legal business name

LAKELAND PHARMACY BERRIEN

Practice address

6418 Deans Hill Rd
Berrien Center, MI 49102-9750

Phone

(269) 473-3082

NPI assigned

Dec 14, 2006

Last updated

Aug 22, 2020By 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

Neil R Johnson, R.PH.

Title

Manager

Phone

(269) 473-3082

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Lakeland Pharmacy Berrien2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lakeland Specialty Hospital

  • Skilled Nursing Facility
  • Berrien Center, MI
  • NPI 1033105549
  NPD tax ID

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902968084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6418 DEANS HILL RD",
            "city": "BERRIEN CENTER",
            "state": "MI",
            "postal_code": "491029750",
            "telephone_number": "269-473-3082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6418 DEANS HILL RD",
            "city": "BERRIEN CENTER",
            "state": "MI",
            "postal_code": "491029750",
            "telephone_number": "269-473-3082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND PHARMACY BERRIEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "269-473-3082",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "MI",
            "license": "5301006978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2367779",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dahn Mulako Imasiku, DP-C
• Michelle Johnson-Mastin
• Tricia Newland Johnson, L.M.S.W
• Thomas Johnston
• Karen Joy Knauss, RD
• Lakeland Specialty Hospital
• Lakeland Specialty Hospital at Berrien Center
• Lakeland Specialty Hospital at Berrien Center
• Laura Marie Landrey, R.D.
• Leslie Louise Liles

• Institutional Pharmacy in Berrien Center, MI
• Providers in Berrien Center, MI by specialty
• Institutional Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.