Organization
LAKE SHORE DRUGS LLC
Active
Other names
Mike's Pharmacy II
Organization subpart
No
Provider details
NPI number
Authorized official
SHALENDRA CHERUKURI (MEMBER)
(410) 255-0099
Entity
Organization
Contact information
Practice address
3820 MOUNTAIN RD UNIT G, PASADENA, MD 21122-2027
(410) 255-0099
(410) 255-0799
Mailing address
3820 MOUNTAIN RD UNIT G, PASADENA, MD 21122-2027
(410) 255-0099
(410) 255-0799
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
P07151
MD
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159782
PK
—
Enumeration date
03/10/2016
Last updated
03/10/2021
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