Provider Demographics
NPI:1346902558
Name:LAKEVIEW PHARMACY IN RACINE SC
Entity Type:Organization
Organization Name:LAKEVIEW PHARMACY IN RACINE SC
Other - Org Name:LAKEVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HAAPANEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:262-632-0520
Mailing Address - Street 1:516 MONUMENT SQ
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1033
Mailing Address - Country:US
Mailing Address - Phone:262-632-0520
Mailing Address - Fax:262-632-6777
Practice Address - Street 1:516 MONUMENT SQ
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1033
Practice Address - Country:US
Practice Address - Phone:262-632-0520
Practice Address - Fax:262-632-6777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEVIEW PHARMACY IN RACINE SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100189504Medicaid