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General NPI Number Information
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NPI Number | 1497078364
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Entity Type | Organization
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Legal Business Name | LAKEVIEW SPECIALTY PHARMACY INC
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 21400 E 11 MILE RD
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1502
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Country | US
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Telephone | 586-777-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 21400 E 11 MILE RD
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1502
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Country | US
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Telephone | 586-777-4100
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Fax |
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Authorized Official
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Title or Position | VP
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Name | ROBERT HARB
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Credential |
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Telephone | 248-454-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 5301009304
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License Number State | MI
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