# LAKESHORE APOTHACARE INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDICINE SHOPPE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568491413
- **Authorized official:** MR. BRIAN C JENSEN R. PH. (OWNER/PRESIDENT)
- **Authorized official phone:** (920) 794-1225

## Contact information

- **Practice address:** 1500 WASHINGTON ST, TWO RIVERS, WI 54241-3045
- **Practice address phone:** (920) 794-1225
- **Practice address fax:** (920) 794-7091
- **Mailing address:** 1500 WASHINGTON ST, TWO RIVERS, WI 54241-3045
- **Mailing address phone:** (920) 794-1225
- **Mailing address fax:** (920) 794-7091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 7778 | WI | Yes |

## Other

- **Enumeration date:** 07/02/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33229600 | — | WI |
| 01 | — | 5124273 | NCPDP \# | WI |