MEDICARE: LAKEVIEW PHARMACY IN RACINE SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477224244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW PHARMACY IN RACINE SC

Provider Business Mailing Address
First Line	:	517 WISCONSIN AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53403-1050
Country	:	US
Telephone Number	:	262-632-8215
Fax Number	:	262-632-6777

Provider Business Practice Location Address
First Line	:	517 WISCONSIN AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53403-1050
Country	:	US
Telephone Number	:	262-632-8215
Fax Number	:	262-632-6777

Authorized Official
Title or Position	:	PHARMACY OWNER
Name	:	MRS. MEGAN RENEE HAAPANEN
Credential	:	PHARMD
Telephone Number	:	262-632-8215

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	01/25/2022

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Directions to “LAKEVIEW PHARMACY IN RACINE SC ” Practice Location

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