Great Lakes RPH

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

GREAT LAKES RPH

Practice address

71 124TH Ave
Shelbyville, MI 49344-9772

Phone

(269) 672-7774

NPI assigned

Jul 18, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael A Holtz, R.PH.

Title

Pharmacist/Owner

Phone

(269) 672-7774

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Gun Lake Pharmacy Doing business as
• WEICK'S PHARMACY Doing business as

Tax ID family

Great Lakes RPH2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Great Lakes R.PH. Corp

  • Long Term Care Pharmacy
  • Shelbyville, MI
  • NPI 1689481236
  NPD tax ID

Locations

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1023017456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 124TH AVE",
            "address_2": "PO BOX 53",
            "city": "SHELBYVILLE",
            "state": "MI",
            "postal_code": "493449772",
            "telephone_number": "269-672-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 124TH AVE",
            "city": "SHELBYVILLE",
            "state": "MI",
            "postal_code": "493449772",
            "telephone_number": "269-672-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES RPH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "HOLTZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "269-672-7774",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "2343250",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gun Lake Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WEICK'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WEICK'S PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Logan Mae Fish
• Cierra Lynn Gabrielse, DPT
• Gabrielle Gray, DC
• Great Lakes R.PH. Corp
• Great Lakes R.PH. Corp
• Michael A Holtz, R.PH.
• Camille Woolf Irvine, MS, RDN
• Bobbi Keyzer, RN
• Angela Nguyen Kienutske
• Colin Kenneth Mandigo, LMSW

• Long Term Care Pharmacy in Shelbyville, MI
• Providers in Shelbyville, MI by specialty
• Long Term Care Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.