| NPI | 1932648896 |
|---|---|
| Doing Business As | GREAT LAKES PHARMACY LLC |
| Entity Type | Organization |
| Authorized Contact | ANIRUDDHA PATHAK Mgr,PIC, AO 443-783-5539 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301011109) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-04-20 |