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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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