Great Lakes Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301011109 Issued in MI

Legal business name

GREAT LAKES PHARMACY LLC

Doing business as

Great Lakes Pharmacy LLC

Practice address

3247 Biddle Ave Ste a
Wyandotte, MI 48192-5951

Phone

(734) 224-6400

Fax

(734) 224-6500

NPI assigned

Feb 13, 2017

Organization subpart

No

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

Authorized official

Name

Aniruddha Pathak, RPHNPI 1326873845

Title

Ao

Phone

(734) 284-5100

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Great Lakes Pharmacy LLC Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aniruddha Pathak, RPH

  • Pharmacist
  • Wyandotte, MI
  • NPI 1326873845
  NPD Authorized official

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

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1932648896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3247 BIDDLE AVE STE A",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481925951",
            "telephone_number": "734-224-6400",
            "fax_number": "734-224-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3247 BIDDLE AVE STE A",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481925951",
            "telephone_number": "734-224-6400",
            "fax_number": "734-224-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "PATHAK",
        "authorized_official_first_name": "ANIRUDDHA",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "734-284-5100",
        "authorized_official_credential": "RPH"
    },
    "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": "5301011109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2167778",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ari S. Gotlib, MD
• Al DG Mandeoya Grande, OTRL
• Alicia Paulette Gray, DO
• Samuel Allen Gray
• Great Lakes Pain Management MD, PC
• Great Lakes Physical Medicine & Rehabilitation PC
• Great Lakes Physical Medicine and Rehabilitation
• Bradley Allen Green, CRNA, MS
• Joshua C. Greenberg, M.D.
• Alexander Antonio Grimaldi, D.O.

• Community/Retail Pharmacy in Wyandotte, MI
• Providers in Wyandotte, 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 8, 2026; 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.