# GREAT LAKES R.PH. CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gun Lake Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689481236
- **Authorized official:** DR. MICHAEL A HOLTZ (PHARMACIST/OWNER)
- **Authorized official phone:** (269) 998-6772

## Contact information

- **Practice address:** 71 124TH AVE, SHELBYVILLE, MI 49344-9772
- **Practice address phone:** (269) 672-7774
- **Practice address fax:** (269) 672-7887
- **Mailing address:** PO BOX 53, SHELBYVILLE, MI 49344-0053
- **Mailing address phone:** (269) 672-7774
- **Mailing address fax:** (269) 672-7887

## Taxonomy

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

## Other

- **Enumeration date:** 12/17/2024
- **Last updated:** 12/17/2024