| NPI | 1154097426 |
|---|---|
| Doing Business As | NORTHSHORE LAPORTE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | DAVID HALL CEO 219-763-8112 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-18 |