NPIMap

Organization Active NPI

Great Lakes Pharmacy Midland, LLC

  • Community/Retail Pharmacy
  • Midland, MI
National Provider Identifier
1942580972
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301009642 Issued in MI
Legal business name
GREAT LAKES PHARMACY MIDLAND, LLC
Practice address
1120 Eastman Ave
Midland, MI 48640-4215
Phone
(989) 835-7911
Fax
(989) 835-6975
NPI assigned
Aug 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Authorized official

Name
Naif Bazzi, PHARMD
Title
Owner/ Pharmacist
Phone
(313) 208-4550

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301009642 MI Primary

Addresses

Primary practice location

1120 Eastman Ave
Midland, MI 48640-4215

Mailing address

1120 Eastman Ave
Midland, MI 48640-4215
Phone (989) 835-7911

Other identifiers 2

IdentifierTypeStateIssuer
1942580972MedicaidMI
2131633OtherPK

Other names 1

  • Great Lakes Pharmacy of Midland Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120125000276 MI DME Supplier - Pharmacy 0446427868 Practice locations: Midland, MI
O20130923000799 MI Part B Supplier - Mass Immunization (Roster Biller Only) 0446427868 Practice locations: Midland, MI

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Pharmacy Midland LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1120 Eastman Ave
Midland, MI 48640
Phone (989) 835-7911

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1313971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1942580972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 EASTMAN AVE",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486404215",
            "telephone_number": "989-835-7911",
            "fax_number": "989-835-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 EASTMAN AVE",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486404215",
            "telephone_number": "989-835-7911",
            "fax_number": "989-835-6975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHARMACY MIDLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-22",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "BAZZI",
        "authorized_official_first_name": "NAIF",
        "authorized_official_title_or_position": "OWNER/ PHARMACIST",
        "authorized_official_telephone_number": "313-208-4550",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942580972",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2131633",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Pharmacy of Midland",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Lakes Pharmacy of Midland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Midland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; 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.