OrganizationActive
Southshore Tribal Health Pharmacy
NPI 1376289322 · Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy · Clearlake, CA
Provider details
- NPI number
- 1376289322
- Entity type
- Organization
- Primary specialty
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacySuppliers
- Parent organization
- Lake County Tribal Health Consortium Inc.
- Organization subpart
- Yes
- Authorized official
- Thomas Burnett, It Specialist(707) 263-8382
Specialties & taxonomies
Suppliers
Practice location
14440 Olympic Drive
Suite B
Clearlake, CA 95422-9545
Phone: (707) 263-8382
Fax: (707) 263-5019
Approximate (ZIP-level) locationGet directions
Mailing address
925 Bevins Ct
Lakeport, CA 95453-9754
Registry dates
- Enumerated
- 2022-05-11
- Last updated
- 2024-08-07
- Certified
- 2024-08-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.