Provider Demographics
NPI:1497078364
Name:LAKEVIEW SPECIALTY PHARMACY INC
Entity Type:Organization
Organization Name:LAKEVIEW SPECIALTY PHARMACY INC
Other - Org Name:LAKEVIEW SPECIALTY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-454-6500
Mailing Address - Street 1:21400 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1502
Mailing Address - Country:US
Mailing Address - Phone:586-777-4100
Mailing Address - Fax:
Practice Address - Street 1:21400 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1502
Practice Address - Country:US
Practice Address - Phone:586-777-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301009304333600000X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373708OtherNCPDP PROVIDER IDENTIFICATION NUMBER