LAKE ODESSA PHARMACY NPI 1831608108

NPI Details

LAKE ODESSA PHARMACY is a community/retail pharmacy pharmacy in Lake Odessa, MI. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. LAKE ODESSA PHARMACY NPI is 1831608108. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake O Rx.

The provider's business location address is:

802 4TH AVE
LAKE ODESSA, MI
ZIP 48849-002
Phone: (877) 855-9777
Fax: (877) 855-8222

The provider's authorized official is Andrea Cusack .
The authorized official title is Owner/pharmacist and has the following contact phone number (877) 855-9777.

The CLIA number assigned to this NPI record is 23D2182455 - pharmacy with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count (HCPCS:K1034)
• Fee covid-19 vac 14 res (HCPCS:0134A)
• Administration of influenza virus vaccine (HCPCS:G0008)
• Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 100 mcg/0.5ml dosage; second dose (HCPCS:0012A)
• Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage (HCPCS:90694)
• Influenza vaccine split virus, preservative free (HCPCS:90662)
• Fee covid-19 vac 13 res (HCPCS:0124A)
• Adm sarscov2 100mcg/0.5ml3rd (HCPCS:0013A)

The enumeration date for this NPI number is 9/29/2017 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available: