Provider Demographics
NPI:1427203967
Name:BEST VALUE PHARMACY LLC
Entity Type:Organization
Organization Name:BEST VALUE PHARMACY LLC
Other - Org Name:LAKESHORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAHALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-483-3910
Mailing Address - Street 1:7310 WOODWARD AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3165
Mailing Address - Country:US
Mailing Address - Phone:313-483-3910
Mailing Address - Fax:313-872-0680
Practice Address - Street 1:7310 WOODWARD AVE FL 4
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3165
Practice Address - Country:US
Practice Address - Phone:313-483-3910
Practice Address - Fax:313-872-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 333600000X
MI53010089833336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118169OtherPK