Organization
GREAT LAKES LTC PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HASSAN ISMAIL R.PH (PHARMACIST/OWNER)
(419) 890-4748
Entity
Organization
Contact information
Practice address
4260 MONROE ST, TOLEDO, OH 43606-1944
(419) 890-4748
(419) 890-4822
Mailing address
4260 MONROE ST, TOLEDO, OH 43606-1944
(313) 982-3220
(313) 982-3221
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
05/03/2022
Last updated
04/18/2023
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