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NPI Code Detail

MEDICARE: LAKEVIEW PHARMACY OF RACINE INC

MEDICARE: LAKEVIEW PHARMACY OF RACINE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0004XCompounding Pharmacy
33336C0003XCommunity/Retail Pharmacy7185-42WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12114710OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154325199
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEVIEW PHARMACY OF RACINE INC
Provider Business Mailing Address
First Line : 516 MONUMENT SQ
Second Line :
City : RACINE
State : WI
Zip : 53403-1033
Country : US
Telephone Number : 262-632-0520
Fax Number : 262-632-6777
Provider Business Practice Location Address
First Line : 516 MONUMENT SQ
Second Line :
City : RACINE
State : WI
Zip : 53403-1033
Country : US
Telephone Number : 262-632-0520
Fax Number : 262-632-6777
Authorized Official
Title or Position : BILLING MANAGER
Name : CHERYL A ROBOTKA
Credential :
Telephone Number : 262-632-1830
Provider Enumeration Date : 06/08/2005
Last Update Date : 08/23/2019

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Directions to “LAKEVIEW PHARMACY OF RACINE INC ” Practice Location

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