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General NPI Number Information
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NPI Number | 1003272436
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Entity Type | Organization
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Legal Business Name | LAKEVIEW PHARMACY, LLC
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 3901 HIGHLAND RD STE D2
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City | WATERFORD
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State | MI
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Zip | 48328-2162
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Country | US
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Telephone | 248-681-5252
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Fax | 248-430-8385
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Provider Business Mailing Address
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Address Line | 3901 HIGHLAND RD STE D2
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City | WATERFORD
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State | MI
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Zip | 48328-2162
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Country | US
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Telephone | 248-681-5252
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Fax | 248-480-8385
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARINA H COLLINS
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Credential |
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Telephone | 248-681-5252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5315073827
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License Number State | MI
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