NPIMap

Organization Active NPI

Lakeshore Pharmacies, Inc.

Doing business as Allegan Community Pharmacy

  • Community/Retail Pharmacy
  • Allegan, MI
National Provider Identifier
1225048978
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301005598 Issued in MI
Legal business name
LAKESHORE PHARMACIES, INC.
Doing business as
Allegan Community Pharmacy
Practice address
115 Locust St
Allegan, MI 49010-1301
Phone
(269) 673-4188
Fax
(269) 673-6773
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Daniel Mark Alexander, R.PH.
Title
President/Pharmacist
Phone
(269) 673-4188

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301005598 MI Primary

Addresses

Primary practice location

115 Locust St
Allegan, MI 49010-1301

Mailing address

115 Locust St
Allegan, MI 49010-1301
Phone (269) 673-4188

Other identifiers 3

IdentifierTypeStateIssuer
2349694MedicaidMI
0002808093MedicaidMI
5301005598OtherMISTATE PHARMACY LICENSE #

Other names 1

  • Allegan Community Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210121000583 MI Part B Supplier - Mass Immunization (Roster Biller Only) 5496169153 2 other NPIs on this enrollment
Practice locations: Allegan, MI; Saugatuck, MI; Fennville, MI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Alexander's Drug Store3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225048978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 LOCUST ST",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490101301",
            "telephone_number": "269-673-4188",
            "fax_number": "269-673-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 LOCUST ST",
            "city": "ALLEGAN",
            "state": "MI",
            "postal_code": "490101301",
            "telephone_number": "269-673-4188",
            "fax_number": "269-673-6773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE PHARMACIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/PHARMACIST",
        "authorized_official_telephone_number": "269-673-4188",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301005598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2349694",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0002808093",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY LICENSE #",
            "identifier": "5301005598",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allegan Community Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Allegan, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.