| NPI | 1669152914 |
|---|---|
| Doing Business As | GRASS LAKE COMMUNITY PHARMACY |
| Entity Type | Organization |
| Authorized Contact | TODD R. RAEHTZ CEO/President 866-964-2638 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2023-07-21 |