Organization
LAKE REGIONAL HEALTH SYSTEM
Active
Other names
LAKE REGIONAL PHARMACY - CMC
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA SUE LITTLETON (CFO)
(573) 348-8388
Entity
Organization
Contact information
Practice address
1930-C NORTH BUSINESS ROUTE 5, CAMDENTON, MO 65020-2659
(573) 346-2300
(573) 346-8409
Mailing address
PO BOX 1560, OSAGE BEACH, MO 65065-1560
(573) 346-2300
(573) 346-8409
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
005731
MO
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2047179
PK
—
05
—
600054704
—
MO
Enumeration date
08/18/2006
Last updated
01/07/2025
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