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General NPI Number Information
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NPI Number | 1295811313
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Entity Type | Organization
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Legal Business Name | LAKEVIEW MEMORIAL HOSPITAL ASSN, INC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 927 CHURCHILL ST W
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City | STILLWATER
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State | MN
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Zip | 55082-6605
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Country | US
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Telephone | 651-430-4562
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Fax | 651-430-8540
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Provider Business Mailing Address
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Address Line | 927 CHURCHILL ST W
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City | STILLWATER
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State | MN
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Zip | 55082-6605
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Country | US
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Telephone | 651-439-5330
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Fax | 651-430-8540
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Authorized Official
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Title or Position | CFO
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Name | DOUGLAS EDWARD JOHNSON
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Credential |
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Telephone | 651-430-4581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 200202-2
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License Number State | MN
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