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Organization
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Active
Organization
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
Active
Other names
Lakeview Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS EDWARD JOHNSON (CFO)
(651) 430-4581
Entity
Organization
Contact information
Practice address
927 CHURCHILL ST W, STILLWATER, MN 55082-6605
(651) 430-4563
(651) 430-4630
Mailing address
927 CHURCHILL ST W, STILLWATER, MN 55082-6605
(651) 430-4563
(651) 430-4630
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
261233
MN
333600000X
Pharmacy
Primary
2612331
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194023600
—
MN
01
—
242458-1
NABP NUMBER
MN
05
—
33218600
—
WI
Enumeration date
10/31/2006
Last updated
02/03/2017
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