Great Lakes R.PH. Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301007296 Issued in MI

Legal business name

GREAT LAKES R.PH. CORP

Practice address

71 124TH Ave
Shelbyville, MI 49344

Phone

(269) 672-7774

Fax

(269) 672-7887

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Michael A Holtz

Title

Owner

Phone

(269) 792-3790

Specialties & licenses 3

Addresses

Other names 2

• Gun Lake Pharmacy Doing business as
• Weick's Pharmacy 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 RPH Corp

  • Community/Retail Pharmacy
  • Grand Rapids, MI
  • NPI 1285963611

  O20081103000609

  Same enrollment

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576454400000",
    "number": "1902970668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 124TH AVE",
            "address_2": "PO BOX 53",
            "city": "SHELBYVILLE",
            "state": "MI",
            "postal_code": "493449772",
            "telephone_number": "269-672-7774",
            "fax_number": "269-672-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 124TH AVE",
            "city": "SHELBYVILLE",
            "state": "MI",
            "postal_code": "49344",
            "telephone_number": "269-672-7774",
            "fax_number": "269-672-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES R.PH. CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A",
        "authorized_official_last_name": "HOLTZ",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-792-3790"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301007296",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gun Lake Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Weick's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Weick's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aubry Rose Draper
• Logan Mae Fish
• Cierra Lynn Gabrielse, DPT
• Gabrielle Gray, DC
• Great Lakes R.PH. Corp
• Great Lakes RPH
• Michael A Holtz, R.PH.
• Camille Woolf Irvine, MS, RDN
• Bobbi Keyzer, RN
• Angela Nguyen Kienutske

• Community/Retail Pharmacy in Shelbyville, MI
• Providers in Shelbyville, 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 Dec 16, 2019; 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.