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Organization
SOUTHSHORE TRIBAL HEALTH PHARMACY
Active
Organization
SOUTHSHORE TRIBAL HEALTH PHARMACY
Active
Parent organization
LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE COUNTY TRIBAL HEALTH CONSORTIUM INC.
Authorized official
MR. THOMAS BURNETT (IT SPECIALIST)
(707) 263-8382
Entity
Organization
Contact information
Practice address
14440 OLYMPIC DRIVE, SUITE B, CLEARLAKE, CA 95422-9545
(707) 263-8382
(707) 263-5019
Mailing address
925 BEVINS CT, LAKEPORT, CA 95453-9754
(707) 263-8382
(707) 263-5019
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
Other
Enumeration date
05/11/2022
Last updated
08/07/2024
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