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General NPI Number Information
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NPI Number | 1063416097
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Entity Type | Organization
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Legal Business Name | LAKEVIEW PHARMACY OF RACINE INC
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 517 WISCONSIN AVE
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City | RACINE
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State | WI
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Zip | 53403-1050
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Country | US
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Telephone | 262-632-8215
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Fax | 262-632-6777
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Provider Business Mailing Address
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Address Line | 517 WISCONSIN AVE
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City | RACINE
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State | WI
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Zip | 53403-1050
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Country | US
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Telephone | 262-632-8215
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Fax | 262-632-6777
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Authorized Official
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Title or Position | OWNER
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Name | PETE CIARAMITA
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Credential | RPH
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Telephone | 262-632-8215
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 7186-42
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License Number State | WI
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