# LAKEVIEW PHARMACY OF RACINE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LAKEVIEW PHARMACY OF RACINE INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154325199
- **Authorized official:** CHERYL A ROBOTKA (BILLING MANAGER)
- **Authorized official phone:** (262) 632-1830

## Contact information

- **Practice address:** 516 MONUMENT SQ, RACINE, WI 53403-1033
- **Practice address phone:** (262) 632-0520
- **Practice address fax:** (262) 632-6777
- **Mailing address:** 516 MONUMENT SQ, RACINE, WI 53403-1033
- **Mailing address phone:** (262) 632-0520
- **Mailing address fax:** (262) 632-6777

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 7185-42 | WI | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 06/08/2005
- **Last updated:** 08/23/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2114710 | PK | — |
| 05 | — | 33069400 | — | WI |