NPI 1376289322
Southshore Tribal Health Pharmacy
Practice location
- Address
- 14440 Olympic Drive Suite B, Clearlake, CA 95422-9545
- Phone
- (707) 263-8382
- Fax
- (707) 263-5019
- Mailing address
- 925 Bevins CT, Lakeport, CA 95453-9754
Authorised official
- Name
- Thomas Burnett
- Title
- It Specialist
- Phone
- (707) 263-8382
Registered specialties
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
Registry record
- NPI
- 1376289322
- Entity type
- Organization
- NPI issued
- 11 May 2022
- Record last updated
- 7 Aug 2024
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.