GREAT LAKES R.PH. CORP (NPI# 1902970668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902970668 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES R.PH. CORP |
| Other Organization Name | WEICK'S PHARMACY |
| Practice Address |
71 124th Ave Shelbyville MI 49344 |
| Mailing Address |
71 124th Ave Po Box 53 Shelbyville MI 49344-9772 |
| Practice Telephone | 2696727774 |
| Practice Fax Number | 2696727887 |
| Mailing Telephone | 2696727774 |
| Mailing Fax Number | 2696727887 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2019-12-16 |
| Authorized Official Name | MICHAEL A HOLTZ (OWNER) |
| Authorized Official Telephone | 2697923790 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | MI | Suppliers | |
| N | 333600000X | Pharmacy | 5301007296 | MI | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
5301007296 | MI | Suppliers |
| Other Name | Type Code |
|---|---|
| Gun Lake Pharmacy | Doing Business As Name - Organization |
| Weick's Pharmacy | Doing Business As Name - Organization |
| Street Address |
71 124TH AVE |
| City | SHELBYVILLE |
| State | MI |
| Zip Code | 49344 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023017456 | Great Lakes Rph | Pharmacy | 71 124th Ave, Shelbyville, MI 49344-9772 | 2005-07-18 |
| 1679573364 | Michael A Holtz | Pharmacist | 71 124th Ave, Shelbyville, MI 49344-9772 | 2005-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972670248 | Daniel Joe Lavengood | Chiropractor | 11925 Marsh Rd, Shelbyville, MI 49344 | 2006-11-29 |
| 1619328879 | Kelsey Mosher | Pharmacist | 2880 Mission Dr, Shelbyville, MI 49344 | 2016-06-28 |
| 1871030122 | Bobbi Keyzer | Registered Nurse | 972 129th Ave, Shelbyville, MI 49344-9509 | 2017-01-25 |
| 1952685588 | Match-e-be-nash-she-wish Band of Pottawatomi Indians | Clinic/Center | 2880 Mission Dr, Shelbyville, MI 49344-9580 | 2011-09-30 |
| 1689232241 | Match-e-be-nash-she-wish Band of Pottawatomi Indians | Pharmacy | 2880 Mission Dr, Shelbyville, MI 49344-9580 | 2019-05-30 |
| 1578961868 | Misty Wuis | Licensed Practical Nurse | 2423 Pearl St, Shelbyville, MI 49344-9700 | 2014-12-18 |
| 1750731972 | Elizabeth Spaulding | Technician, Other | 2535 7th St Apt 6, Shelbyville, MI 49344-9761 | 2016-06-18 |
| 1053941088 | Camille Woolf Irvine | Dietitian, Registered | 5419 Fawn Lake Dr, Shelbyville, MI 49344-9780 | 2020-01-17 |
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| 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. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1992808760 | Highland Park Cvs, L.L.C. | Pharmacy | 110 N Cedar St, Shelbyville, IL 62565-1242 | 2006-09-07 |
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| 1992792345 | Rx Stores LLC | Pharmacy | 1603 W Main St, Shelbyville, IL 62565-9571 | 2005-09-30 |
| 1811090509 | Tennessee Cvs Pharmacy, L.L.C. | Pharmacy | 825 N Main St, Shelbyville, TN 37160-2841 | 2006-09-07 |
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| 1023621190 | Azam Mohsen Mesleh | Pharmacy | 6811 Theisen St, Dearborn, MI 48126-1927 | 2020-08-28 |
| 1821606310 | S&k Pharmacy Inc. | Pharmacy | 1916 Davison Rd, Flint, MI 48506-4423 | 2020-07-21 |
| Find all providers with the same taxonomy | ||||
| City | SHELBYVILLE |
| Zip Code | 49344 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.