Healthcare Provider Details

I. General information

NPI: 1477224244
Provider Name (Legal Business Name): LAKEVIEW PHARMACY IN RACINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 WISCONSIN AVE
RACINE WI
53403-1050
US

IV. Provider business mailing address

517 WISCONSIN AVE
RACINE WI
53403-1050
US

V. Phone/Fax

Practice location:
  • Phone: 262-632-8215
  • Fax: 262-632-6777
Mailing address:
  • Phone: 262-632-8215
  • Fax: 262-632-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEGAN RENEE HAAPANEN
Title or Position: PHARMACY OWNER
Credential: PHARMD
Phone: 262-632-8215