# LAKE REGIONAL HEALTH SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKE REGIONAL PHARMACY - OBMP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134233109
- **Authorized official:** PAULA SUE LITTLETON (CFO)
- **Authorized official phone:** (573) 348-8388

## Contact information

- **Practice address:** 1057B MEDICAL PARK DR, OSAGE BEACH, MO 65065-3000
- **Practice address phone:** (573) 302-2700
- **Practice address fax:** (573) 302-2701
- **Mailing address:** PO BOX 1560, OSAGE BEACH, MO 65065-1560
- **Mailing address phone:** (573) 302-2700
- **Mailing address fax:** (573) 302-2701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | 2001028176 | MO | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 01/07/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2048736 | PK | — |
| 05 | — | 605918507 | — | MO |