Provider Demographics
NPI:1326178948
Name:LAKEVIEW HOSPITAL INC.
Entity Type:Organization
Organization Name:LAKEVIEW HOSPITAL INC.
Other - Org Name:HIGH POINTE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:SCHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-702-7212
Mailing Address - Street 1:8650 HUDSON BLVD N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-9747
Mailing Address - Country:US
Mailing Address - Phone:651-702-7212
Mailing Address - Fax:651-702-7211
Practice Address - Street 1:8650 HUDSON BLVD N
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-9747
Practice Address - Country:US
Practice Address - Phone:651-702-7212
Practice Address - Fax:651-702-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26160813336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340326200Medicaid
MN0945820002Medicare NSC