NPIMap

Organization Active NPI

Great Lakes RX Sav Mor Pharmacy

  • Community/Retail Pharmacy
  • Lincoln Park, MI
National Provider Identifier
1982888947
Registry record updated May 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301008773 Issued in MI
Legal business name
GREAT LAKES RX SAV MOR PHARMACY
Practice address
1770 Fort St
Lincoln Park, MI 48146-1904
Phone
(313) 827-9999
Fax
(313) 827-0999
NPI assigned
Dec 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2009

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

Authorized official

Name
Wael Khanafer
Title
Owner
Phone
(133) 412-4622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301008773 MI Primary

Addresses

Primary practice location

1770 Fort St
Lincoln Park, MI 48146-1904

Mailing address

1770 Fort St
Lincoln Park, MI 48146-1904

Other identifiers 1

IdentifierTypeStateIssuer
2370702OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • GREAT LAKES RX PHARMACY Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1198627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241740800000",
    "number": "1982888947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481461904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 FORT ST",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481461904",
            "telephone_number": "313-827-9999",
            "fax_number": "313-827-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES RX SAV MOR PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-26",
        "last_updated": "2009-05-08",
        "status": "A",
        "authorized_official_last_name": "KHANAFER",
        "authorized_official_first_name": "WAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "133-412-4622"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008773",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2370702",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREAT LAKES RX PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincoln Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2009; 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.