Organization
LAKE HOSPITAL SYSTEM INC
Active
Other names
LAKE HEALTH PHARMACY - WEST
Organization subpart
No
Provider details
NPI number
Authorized official
CARL OBENDORF (DIRECTOR)
(440) 375-8791
Entity
Organization
Contact information
Practice address
36000 EUCLID AVE, WILLOUGHBY, OH 44094-4625
(440) 375-8790
Mailing address
36000 EUCLID AVE, WILLOUGHBY, OH 44094-4625
(440) 375-8790
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
022537500
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153555
PK
—
Enumeration date
09/11/2015
Last updated
09/11/2015
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