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General NPI Number Information
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NPI Number | 1487664330
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Entity Type | Organization
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Legal Business Name | LAKESHORE PHARMACIES, INC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 211 EAST MAIN STREET
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City | FENNVILLE
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State | MI
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Zip | 49408
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Country | US
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Telephone | 269-561-4411
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Fax | 269-561-5474
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Provider Business Mailing Address
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Address Line | PO BOX 28
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City | FENNVILLE
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State | MI
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Zip | 49408
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Country | US
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Telephone | 269-561-4411
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Fax | 269-561-5474
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DANIEL MARK ALEXANDER
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Credential | RPH.
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Telephone | 269-561-4411
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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 | 5301005615
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License Number State | MI
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