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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