Organization
GREAT LAKES PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY ANNE MALKAMAKI RPH (PHARMACY MANAGER/OWNER)
(440) 352-2500
Entity
Organization
Contact information
Practice address
9500 MENTOR AVE, SUITE # 110, MENTOR, OH 44060-8713
(440) 352-2500
(440) 352-2554
Mailing address
9500 MENTOR AVE, SUITE # 110, MENTOR, OH 44060-8713
(440) 352-2500
(440) 352-2554
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Enumeration date
06/08/2014
Last updated
05/17/2020
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