Organization
GREAT LAKES R.PH. CORP
Active
Organization
GREAT LAKES R.PH. CORP
Active
Other names
Gun Lake Pharmacy, Weick's Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A HOLTZ (OWNER)
(269) 792-3790
Entity
Organization
Contact information
Practice address
71 124TH AVE, SHELBYVILLE, MI 49344
(269) 672-7774
(269) 672-7887
Mailing address
71 124TH AVE, PO BOX 53, SHELBYVILLE, MI 49344-9772
(269) 672-7774
(269) 672-7887
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
MI
333600000X
Pharmacy
5301007296
MI
3336C0003X
Community/Retail Pharmacy
Primary
5301007296
MI
Other
Enumeration date
11/17/2006
Last updated
12/16/2019
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