Organization
LAKESHORE APOTHACARE INC
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
2219 GARFIELD ST, TWO RIVERS, WI 54241-2416
(920) 793-2927
(920) 794-8783
Mailing address
2219 GARFIELD ST, TWO RIVERS, WI 54241-2416
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
7221
WI
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33185800
—
WI
01
—
5121087
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/06/2006
Last updated
03/07/2023
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