# GREAT LAKES LTC PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013652163
- **Authorized official:** HASSAN ISMAIL R.PH (PHARMACIST/OWNER)
- **Authorized official phone:** (419) 890-4748

## Contact information

- **Practice address:** 4260 MONROE ST, TOLEDO, OH 43606-1944
- **Practice address phone:** (419) 890-4748
- **Practice address fax:** (419) 890-4822
- **Mailing address:** 4260 MONROE ST, TOLEDO, OH 43606-1944
- **Mailing address phone:** (313) 982-3220
- **Mailing address fax:** (313) 982-3221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/03/2022
- **Last updated:** 04/18/2023