Organization
LAKE HEALTH SERVICES
Active
Parent organization
LAKE HEALTH SERVICES
Other names
Lake Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKE HEALTH SERVICES
Authorized official
TIM NGUYEN PHARMD (PRESIDENT)
(925) 586-2112
Entity
Organization
Contact information
Practice address
15230 LAKESHORE DR, CLEARLAKE, CA 95422
(707) 994-3141
(707) 994-7150
Mailing address
PO BOX 6376, CLEARLAKE, CA 95422-7150
(707) 994-3141
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY55420
CA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2001004
PK
—
05
—
PHA471230
—
CA
Enumeration date
06/30/2005
Last updated
05/01/2020
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