Organization
GREAT LAKES COMPOUNDING PHARMACY
Active
Organization
GREAT LAKES COMPOUNDING PHARMACY
Active
Parent organization
SYNANON, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SYNANON, INC
Authorized official
DARCY TUSSING RPH (DIR OF PHRM)
(616) 847-5230
Entity
Organization
Contact information
Practice address
1445 SHELDON RD, 104A, GRAND HAVEN, MI 49417-2480
(616) 842-1223
(616) 842-0930
Mailing address
1445 SHELDON RD, 104A, GRAND HAVEN, MI 49417-2480
(616) 842-5193
(616) 842-0930
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008607
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2369658
OTHER ID NUMBER
—
Enumeration date
08/30/2007
Last updated
07/08/2008
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