Organization
LAKELAND IMMEDIATE CARE CENTER
Active
Parent organization
LAKELAND IMMEDIATE CARE CENTER
Other names
Niles Community Health Center Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKELAND IMMEDIATE CARE CENTER
Authorized official
JOSEPH GAVAN (CEO)
(269) 445-3874
Entity
Organization
Contact information
Practice address
1951 OAK ST, NILES, MI 49120-3738
(269) 262-4749
Mailing address
1951 OAK ST, NILES, MI 49120-3738
(269) 262-4749
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144866310
—
MI
Enumeration date
11/22/2019
Last updated
09/04/2025
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