NPIMap

Organization Active NPI

Lake Hospital System Inc

Doing business as Lake Health Pharmacy - West

  • Community/Retail Pharmacy
  • Willoughby, OH
National Provider Identifier
1912375601
Registry record updated Sep 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
022537500 Issued in OH
Legal business name
LAKE HOSPITAL SYSTEM INC
Doing business as
Lake Health Pharmacy - West
Practice address
36000 Euclid Ave
Willoughby, OH 44094-4625
Phone
(440) 375-8790
NPI assigned
Sep 11, 2015
Last updated
Sep 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2015

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

Authorized official

Name
Carl Obendorf
Title
Director
Phone
(440) 375-8791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 022537500 OH Primary

Addresses

Primary practice location

36000 Euclid Ave
Willoughby, OH 44094-4625

Mailing address

36000 Euclid Ave
Willoughby, OH 44094-4625
Phone (440) 375-8790

Other identifiers 1

IdentifierTypeStateIssuer
2153555OtherPK

Other names 1

  • LAKE HEALTH PHARMACY - WEST Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lake Medical Center37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441929600000",
    "number": "1912375601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36000 EUCLID AVE",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944625",
            "telephone_number": "440-375-8790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36000 EUCLID AVE",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440944625",
            "telephone_number": "440-375-8790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE HOSPITAL SYSTEM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-09-11",
        "status": "A",
        "authorized_official_last_name": "OBENDORF",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "440-375-8791"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OH",
            "license": "022537500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153555",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE HEALTH PHARMACY - WEST",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2015; 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.