# LAKESHORE APOTHACARE INC

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

## Provider details

- **NPI number:** 1821191974
- **Authorized official:** DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
- **Authorized official phone:** (314) 993-6000

## Contact information

- **Practice address:** 2219 GARFIELD ST, TWO RIVERS, WI 54241-2416
- **Practice address phone:** (920) 793-2927
- **Practice address fax:** (920) 794-8783
- **Mailing address:** 2219 GARFIELD ST, TWO RIVERS, WI 54241-2416

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 7221 | WI | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/06/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33185800 | — | WI |
| 01 | — | 5121087 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |