Great Lakes RPH Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009259 Issued in MI

Legal business name

GREAT LAKES RPH CORP

Practice address

2500 E Beltline Ave SE Ste O
Grand Rapids, MI 49546-5987

Phone

(616) 949-4499

Fax

(616) 949-9890

NPI assigned

Dec 14, 2009

Organization subpart

No

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

Authorized official

Name

Michael Holtz

Title

Pharmacist

Phone

(269) 672-7774

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Woodpointe Pharmacy Corp Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Great Lakes R.PH. Corp

  • Community/Retail Pharmacy
  • Shelbyville, MI
  • NPI 1902970668

  O20081103000609

  Same enrollment

Locations

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

{
    "created_epoch": "1260748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437696000000",
    "number": "1285963611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 E BELTLINE AVE SE",
            "address_2": "SUITE O",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465987",
            "telephone_number": "616-949-4499",
            "fax_number": "616-949-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 E BELTLINE AVE SE STE O",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465987",
            "telephone_number": "616-949-4499",
            "fax_number": "616-949-9890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES RPH CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-14",
        "last_updated": "2015-07-24",
        "status": "A",
        "authorized_official_last_name": "HOLTZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "269-672-7774"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2123017",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodpointe Pharmacy Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Great Lakes Hearing
• Great Lakes Jaw Surgery, PC
• Great Lakes Neurosurgical Associates, PC
• Great Lakes Neurosurgical Associates, PC
• Great Lakes Psychiatric Services, P.C.
• Great Lakes Sleep Care PLLC
• Great Lakes Specialists LLC
• Great Lakes Specialty Hospital - Oak LLC
• Lauren Greathead
• Inez Chantal Greathouse

• Community/Retail Pharmacy in Grand Rapids, MI
• Providers in Grand Rapids, 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 Jul 24, 2015; 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.