Organization
GREAT LAKES RPH
Active
Other names
WEICK'S PHARMACY, Gun Lake Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A HOLTZ R.PH. (PHARMACIST/OWNER)
(269) 672-7774
Entity
Organization
Contact information
Practice address
71 124TH AVE, SHELBYVILLE, MI 49344-9772
(269) 672-7774
Mailing address
71 124TH AVE, PO BOX 53, SHELBYVILLE, MI 49344-9772
(269) 672-7774
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2343250
NCPDP #
MI
Enumeration date
07/18/2005
Last updated
12/17/2024
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