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General NPI Number Information
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NPI Number | 1366844284
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Entity Type | Organization
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Legal Business Name | LAKE HOSPITAL SYSTEM, INC. DBA LAKE HEALTH
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 7580 AUBURN RD
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City | CONCORD TOWNSHIP
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State | OH
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Zip | 44077-9615
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Country | US
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Telephone | 440-602-6320
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Fax |
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Provider Business Mailing Address
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Address Line | 7580 AUBURN RD
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City | CONCORD TOWNSHIP
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State | OH
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Zip | 44077-9615
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Country | US
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Telephone | 440-602-6320
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MICHAEL KITTOE
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Credential |
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Telephone | 440-354-1051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 02445650 03
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License Number State | OH
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