Organization
LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC.
Active
Parent organization
LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC.
Other names
LAKE COUNTY TRIBAL HEALTH PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC.
Authorized official
MR. ERNESTO PADILLA JR. (EXECUTIVE DIRECTOR)
(707) 263-8382
Entity
Organization
Contact information
Practice address
925 BEVINS CT, LAKEPORT, CA 95453-9754
(707) 263-8382
(707) 263-3790
Mailing address
925 BEVINS CT, LAKEPORT, CA 95453-9754
(707) 263-8382
(707) 263-3790
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
51235
CA
3336C0002X
Clinic Pharmacy
51235
CA
3336C0003X
Community/Retail Pharmacy
Primary
51235
CA
Other
Enumeration date
04/23/2013
Last updated
04/25/2013
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