LAKE HEALTH SERVICES (NPI# 1770580268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770580268 |
| Entity Type | Organization |
| Organization Name | LAKE HEALTH SERVICES |
| Other Organization Name | LAKE PHARMACY |
| Practice Address |
15230 Lakeshore Dr Clearlake CA 95422 |
| Mailing Address |
Po Box 6376 Clearlake CA 95422-7150 |
| Practice Telephone | 7079943141 |
| Practice Fax Number | 7079947150 |
| Mailing Telephone | 7079943141 |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2020-05-01 |
| Authorized Official Name | TIM NGUYEN (PRESIDENT) |
| Authorized Official Telephone | 9255862112 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | Y |
| Parent Organization Name | LAKE HEALTH SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
PHY55420 | CA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | PHA471230 | 05 | |
| PK | 2001004 | 01 |
| Other Name | Type Code |
|---|---|
| LAKE HEALTH SERVICES | Former Legal Business Name - Organization |
| Lake Pharmacy | Doing Business As Name - Organization |
| Street Address |
15230 LAKESHORE DR |
| City | CLEARLAKE |
| State | CA |
| Zip Code | 95422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386254134 | Jaykumar Maradia | Registered Nurse | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2020-08-06 |
| 1730710617 | Veronica Garcia Arroyo | Community Health Worker | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2020-01-30 |
| 1407494818 | Thomas Pickett | Physician Assistant | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2019-12-16 |
| 1962043174 | Srikanth Mudumba | Pharmacist | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2019-09-30 |
| 1780140046 | Rommel B Gayagoy | Nurse Practitioner | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2019-02-12 |
| 1972084879 | Trina Chung | Dentist | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2018-08-28 |
| 1558849661 | Sonja Derose | Family Medicine | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2018-07-31 |
| 1255838603 | Crystine L'heraux | Nurse Practitioner | 15230 Lakeshore Dr, Clearlake, CA 95422 | 2018-04-11 |
| 1760997951 | Tammy Ezinne Onu | Physician Assistant | 15230 Lakeshore Dr, Clearlake, CA 95422 | 2017-12-09 |
| 1487165817 | Olatunde Omoleye Owoeye | Registered Nurse | 15230 Lakeshore Dr, Clearlake, CA 95422-8107 | 2017-10-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831729201 | Richard Charles Hammond | Counselor | 7000 B South Center Drive, Clearlake, CA 95422 | 2020-01-24 |
| 1609416437 | Junirose Thom | Behavioral Analyst | 4456 Manzanita Avenue Suite 2, Clearlake, CA 95422 | 2020-01-09 |
| 1649781360 | Lake County Office of Education | Local Education Agency (LEA) | 3350 Acacia St, Clearlake, CA 95422 | 2017-10-20 |
| 1083091326 | Noelle Menesini | Physician Assistant | 15230 Lake Shore Drive, Clearlake, CA 95422 | 2015-05-06 |
| 1861820979 | Lake County Office of Education | Local Education Agency (LEA) | 6945 Old Highway 53, Clearlake, CA 95422 | 2013-10-29 |
| 1124469838 | Hassan Sheikh Moghaddas | Surgery | 15332 Lakeshore Dr Ste 101, Clearlake, CA 95422 | 2013-07-10 |
| 1366710279 | Nancy Bylund | Licensed Psychiatric Technician | 7000b South Center Drive, Clearlake, CA 95422 | 2011-12-06 |
| 1699060830 | Planned Parenthood Shasta Pacific | Clinic/Center | 1437 Olympic Drive, Cleaklake, CA 95422 | 2011-06-16 |
| 1164655247 | Hector Lara | Counselor | 14130 Lakeshore Dr., Clearlake, CA 95422 | 2009-08-24 |
| 1518197607 | Vishal V Desai | Pharmacist | 15025, Olympic Drive, Clearlake, CA 95422 | 2009-07-23 |
| Find all providers in zip 95422 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154312254 | Clear Script Company Inc | Pharmacy | 15175 Lakeshore Dr, Clearlake, CA 95422-8106 | 2005-10-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720689987 | Capsule San Diego LLC | Pharmacy | 1450 Columbia St Ste B, San Diego, CA 92101-3487 | 2020-11-04 |
| 1023618824 | Ingram's Pharmacy, LLC | Pharmacy | 1115 Union Ave Unit 147-1c, Bakersfield, CA 93307-1050 | 2020-10-29 |
| 1750981874 | Capsule San Francisco LLC | Pharmacy | 475 University Ave, Palo Alto, CA 94301-1814 | 2020-10-28 |
| 1447850623 | Sterling Hatteras LLC | Pharmacy | 916 E Cypress Ave Ste 300, Redding, CA 96002-1038 | 2020-10-28 |
| 1922608454 | Vanessa Ann Marie Rita Pitts | Pharmacy | 26365 Buccaneer Ln, Helendale, CA 92342-7739 | 2020-10-26 |
| 1205435971 | Rinaldi Pharmacy, Inc. | Pharmacy | 11237 Tampa Ave, Porter Ranch, CA 91326-1610 | 2020-10-22 |
| 1467051300 | San Dimas Wellness Pharmacy | Pharmacy | 830 W Arrow Hwy Ste 830b, San Dimas, CA 91773-2498 | 2020-10-21 |
| 1225636889 | Med-plus Pharmacy Inc | Pharmacy | 335 Lindbergh Ave, Livermore, CA 94551-9291 | 2020-10-15 |
| 1689271066 | Innova Pharmacy Iv | Pharmacy | 4815 Watt Ave Ste B101, North Highlands, CA 95660-5108 | 2020-10-08 |
| 1114524683 | Bear Valley Pharmacy | Pharmacy | 17003 Bear Valley Rd Ste B, Hesperia, CA 92345-1420 | 2020-10-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.