OrganizationActiveAccepts Medicare
Lakewood Health System
NPI 1508630112 · Community/Retail Pharmacy · Staples, MN
Enrolled with Medicare as Dme Supplier - Pharmacy · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1508630112
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Parent organization
- Lakewood Health System
- Organization subpart
- Yes
- Authorized official
- Joseph Reycraft, Cfo(218) 894-8194
Specialties & taxonomies
Suppliers
- Compounding Pharmacy3336C0004X
Suppliers
Profile Score
Established profile(57/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
49725 County 83 Ste 100
Staples, MN 56479-5280
Phone: (218) 894-8761
Fax: (218) 894-8762
Street-level locationGet directions
Mailing address
49725 County 83
Staples, MN 56479-5280
Other names (DBA / former)
- Doing business as
- Longbella Drug By Lakewood Health System - Staples Clinic
Registry dates
- Enumerated
- 2023-11-14
- Last updated
- 2025-06-09
- Certified
- 2025-06-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.