Healthcare Provider Details

I. General information

NPI: 1376189688
Provider Name (Legal Business Name): MEGHAN LAKOSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22801 HARPER AVE
SAINT CLAIR SHORES MI
48080-1848
US

IV. Provider business mailing address

23627 MYRTLE ST
CLINTON TOWNSHIP MI
48036-2931
US

V. Phone/Fax

Practice location:
  • Phone: 586-800-5190
  • Fax: 586-800-5195
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302034190
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: