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General NPI Number Information
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NPI Number | 1013429711
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Entity Type | Organization
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Legal Business Name | LAKE LANSING RX LLC
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Dates
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Enumeration Date | 11/02/2017
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 1540 LAKE LANSING RD STE 106
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City | LANSING
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State | MI
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Zip | 48912-3757
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Country | US
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Telephone | 517-455-7355
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Fax | 517-455-7523
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Provider Business Mailing Address
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Address Line | 6689 ORCHARD LAKE RD # 168
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3404
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Country | US
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Telephone | 248-862-6148
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Fax | 248-862-6132
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Authorized Official
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Title or Position | DIRECTOR
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Name | CANDI TOLF
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Credential |
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Telephone | 313-751-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010817
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License Number State | MI
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