Healthcare Provider Details

I. General information

NPI: 1497078364
Provider Name (Legal Business Name): LAKEVIEW SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21400 E 11 MILE RD
SAINT CLAIR SHORES MI
48081-1502
US

IV. Provider business mailing address

21400 E 11 MILE RD
SAINT CLAIR SHORES MI
48081-1502
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-4100
  • Fax:
Mailing address:
  • Phone: 586-777-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301009304
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HARB
Title or Position: VP
Credential:
Phone: 248-454-6500