Great Lakes Pharmacies I Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301004106 Issued in MI

Legal business name

GREAT LAKES PHARMACIES I INC

Doing business as

Village Pharmacy

Practice address

6213 Chicago Rd Suite 200
Warren, MI 48092

Phone

(586) 751-7979

Fax

(586) 751-0809

NPI assigned

Aug 27, 2006

Last updated

Apr 22, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Harb, RPH

Title

Owner/RPH

Phone

(248) 867-1683

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• VILLAGE PHARMACY Doing business as

Tax ID family

Great Lakes Pharmacies I Inc2 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 Pharmacies I Inc

  dba Village Pharmacy

  • Long Term Care Pharmacy
  • Warren, MI
  • NPI 1619510328
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexander W Siomka, RPH

  • Pharmacist
  • Warren, MI
  • NPI 1689736209
  NPD (past)

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

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1093823460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6213 CHICAGO RD. SUITE 200",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48092",
            "telephone_number": "586-751-7979",
            "fax_number": "586-751-0809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6213 CHICAGO RD SUITE 200",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "48092",
            "telephone_number": "586-751-7979",
            "fax_number": "586-751-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHARMACIES I INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "HARB",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER/RPH",
        "authorized_official_telephone_number": "248-867-1683",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301004106",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MI",
            "license": "5301004106",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1617121",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2338499",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Great Lakes MRI of Michigan LLC
• Great Lakes Pediatrics
• Great Lakes Pharmacies I Inc (Village Pharmacy)
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• Great Lakes Seniors PC
• Greater Care Pharmacy LLC
• Greater Care Pharmacy LLC (Greater Care Pharmacy)

• Community/Retail Pharmacy in Warren, MI
• Providers in Warren, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.