Organization
LAKESHORE APOTHACARE INC.
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN C JENSEN R. PH. (OWNER/PRESIDENT)
(920) 794-1225
Entity
Organization
Contact information
Practice address
1500 WASHINGTON ST, TWO RIVERS, WI 54241-3045
(920) 794-1225
(920) 794-7091
Mailing address
1500 WASHINGTON ST, TWO RIVERS, WI 54241-3045
(920) 794-1225
(920) 794-7091
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
7778
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33229600
—
WI
01
—
5124273
NCPDP #
WI
Enumeration date
07/02/2006
Last updated
03/07/2023
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