Organization
GREAT LAKES PHARMACIES I INC
Active
Other names
VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT HARB RPH (OWNER/RPH)
(248) 867-1683
Entity
Organization
Contact information
Practice address
6213 CHICAGO RD SUITE 200, WARREN, MI 48092
(586) 751-7979
(586) 751-0809
Mailing address
6213 CHICAGO RD. SUITE 200, WARREN, MI 48092
(586) 751-7979
(586) 751-0809
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301004106
MI
3336L0003X
Long Term Care Pharmacy
5301004106
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1617121
—
MI
01
—
2338499
OTHER ID NUMBER
—
Enumeration date
08/27/2006
Last updated
04/22/2024
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