Provider Demographics
NPI:1003272436
Name:LAKEVIEW PHARMACY, LLC
Entity Type:Organization
Organization Name:LAKEVIEW PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-681-5252
Mailing Address - Street 1:3901 HIGHLAND RD STE D2
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2162
Mailing Address - Country:US
Mailing Address - Phone:248-681-5252
Mailing Address - Fax:248-480-8385
Practice Address - Street 1:3901 HIGHLAND RD STE D2
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2162
Practice Address - Country:US
Practice Address - Phone:248-681-5252
Practice Address - Fax:248-430-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53150738273336C0003X
MI5301010771333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy