Provider Demographics
NPI:1093720823
Name:GREAT LAKES MEDICAL CARE INC
Entity Type:Organization
Organization Name:GREAT LAKES MEDICAL CARE INC
Other - Org Name:GREAT NORTHERN DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIERI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-733-8022
Mailing Address - Street 1:20724 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ONAWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49765-0100
Mailing Address - Country:US
Mailing Address - Phone:989-733-8022
Mailing Address - Fax:989-733-2460
Practice Address - Street 1:20724 STATE ST
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765-0100
Practice Address - Country:US
Practice Address - Phone:989-733-8022
Practice Address - Fax:989-733-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010042353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2335328OtherNCPDP