Organization
WASHINGTON STATE DEPT OF SOCIAL AND HEALTH SERVICES
Active
Organization
WASHINGTON STATE DEPT OF SOCIAL AND HEALTH SERVICES
Active
Other names
Lakeland Village Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CARMEN JOY BERG RPH (CLINICAL PHARMACIST SUPERVISOR)
(509) 299-1948
Entity
Organization
Contact information
Practice address
S 2320 SALNAVE ROAD, MEDICAL LAKE, WA 99022-0200
(509) 299-1948
(509) 299-1967
Mailing address
PO BOX 200, S 2320 SALNAVE ROAD, MEDICAL LAKE, WA 99022-0200
(509) 299-1948
(509) 299-1967
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHAR.CF.00000468
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4904795
NCPDP
WA
Enumeration date
12/18/2006
Last updated
03/07/2023
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