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General NPI Number Information
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NPI Number | 1932347044
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Entity Type | Organization
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Legal Business Name | LAKELAND PHARMACY PC
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 5589 E M36 STE A10
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City | PINCKNEY
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State | MI
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Zip | 48169-9260
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Country | US
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Telephone | 810-231-2020
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Fax | 810-231-2258
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Provider Business Mailing Address
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Address Line | PO BOX 5185
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City | DEARBORN
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State | MI
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Zip | 48128-0185
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALI FAKIH
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Credential |
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Telephone | 810-231-2020
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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 | 5301009067
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License Number State | MI
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