Great Lakes LTC Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

GREAT LAKES LTC PHARMACY LLC

Practice address

4260 Monroe St
Toledo, OH 43606-1944

Phone

(419) 890-4748

Fax

(419) 890-4822

NPI assigned

May 3, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hassan Ismail, R.PH

Title

Pharmacist/Owner

Phone

(419) 890-4748

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1013652163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4260 MONROE ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436061944",
            "telephone_number": "313-982-3220",
            "fax_number": "313-982-3221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4260 MONROE ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436061944",
            "telephone_number": "419-890-4748",
            "fax_number": "419-890-4822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES LTC PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-03",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "ISMAIL",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "419-890-4748",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.