NPIMap

Organization Active NPI

Great Lakes Compounding Pharmacy

  • Community/Retail Pharmacy
  • Grand Haven, MI
National Provider Identifier
1720272016
Registry record updated Jul 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301008607 Issued in MI
Legal business name
GREAT LAKES COMPOUNDING PHARMACY
Practice address
1445 Sheldon Rd
104A
Grand Haven, MI 49417-2480
Phone
(616) 842-1223
Fax
(616) 842-0930
NPI assigned
Aug 30, 2007
Organization subpart
Yes
Parent organization
SYNANON, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2008

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

Authorized official

Name
Darcy Tussing, RPH
Title
Dir of PHRM
Phone
(616) 847-5230

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301008607 MI Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1445 Sheldon Rd
104A
Grand Haven, MI 49417-2480

Mailing address

1445 Sheldon Rd
104A
Grand Haven, MI 49417-2480
Phone (616) 842-5193

Other identifiers 1

IdentifierTypeStateIssuer
2369658OtherOTHER ID NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Synanon Inc3 organizations share this tax ID, including this one
Part of
Synanon Inc

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": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1720272016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1445 SHELDON RD",
            "address_2": "104A",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172480",
            "telephone_number": "616-842-5193",
            "fax_number": "616-842-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 SHELDON RD",
            "address_2": "104A",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172480",
            "telephone_number": "616-842-1223",
            "fax_number": "616-842-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES COMPOUNDING PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SYNANON, INC",
        "enumeration_date": "2007-08-30",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "TUSSING",
        "authorized_official_first_name": "DARCY",
        "authorized_official_title_or_position": "DIR OF PHRM",
        "authorized_official_telephone_number": "616-847-5230",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008607",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2369658",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; 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.