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Organization
GREAT LAKES R.PH. CORP
Active
Organization
GREAT LAKES R.PH. CORP
Active
Other names
Gun Lake Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A HOLTZ (PHARMACIST/OWNER)
(269) 998-6772
Entity
Organization
Contact information
Practice address
71 124TH AVE, SHELBYVILLE, MI 49344-9772
(269) 672-7774
(269) 672-7887
Mailing address
PO BOX 53, SHELBYVILLE, MI 49344-0053
(269) 672-7774
(269) 672-7887
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Enumeration date
12/17/2024
Last updated
12/17/2024
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