Great Lakes Pharmacy

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

GREAT LAKES PHARMACY

Practice address

9500 Mentor Ave
Suite # 110
Mentor, OH 44060-8713

Phone

(440) 352-2500

Fax

(440) 352-2554

NPI assigned

Jun 8, 2014

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly Anne Malkamaki, RPH

Title

Pharmacy Manager/Owner

Phone

(440) 352-2500

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1402185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589673600000",
    "number": "1467865337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 MENTOR AVE",
            "address_2": "SUITE # 110",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608713",
            "telephone_number": "440-352-2500",
            "fax_number": "440-352-2554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 MENTOR AVE",
            "address_2": "SUITE # 110",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440608713",
            "telephone_number": "440-352-2500",
            "fax_number": "440-352-2554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-08",
        "last_updated": "2020-05-17",
        "certification_date": "2020-05-17",
        "status": "A",
        "authorized_official_last_name": "MALKAMAKI",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PHARMACY MANAGER/OWNER",
        "authorized_official_telephone_number": "440-352-2500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RPH"
    },
    "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
        },
        {
            "code": "3336M0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Mail Order Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lake Dental Arts
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• Great Lakes Eyecare, LLC
• Great Lakes Gastroenterology Research
• Great Lakes Home Health Ohio 2, LLC (Elara Caring)
• Jennifer L Grebenc, RDN LD
• Victor Steven Greco, D.D.S.
• Autumn D Green-Jones, RN
• Adrianne Green
• Edmund Green, LMT

• Long Term Care Pharmacy in Mentor, OH
• Providers in Mentor, OH by specialty
• Long Term Care Pharmacy in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2020; 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.