Great Lakes Pharmacy
Pharmacy, Long Term Care Pharmacy in Mentor, OH. Organization (NPI-2).
NPI number1467865337
StatusActive
Last updated in NPPESMay 17, 2020
Details
- NPI
- 1467865337
- Entity type
- Organization (NPI-2)
- Legal business name
- Great Lakes Pharmacy
- Organization subpart
- No
- Enumeration date
- Jun 8, 2014
- Certification date
- May 17, 2020
- Last updated
- May 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336L0003X | Pharmacy, Long Term Care Pharmacy | – | – | Yes |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | |
| 3336M0002X | Pharmacy, Mail Order Pharmacy | – | – |
Practice location
9500 Mentor AveSuite # 110
Mentor, OH 44060-8713
Phone 440-352-2500 · Fax 440-352-2554
Mailing address
9500 Mentor AveSuite # 110
Mentor, OH 44060-8713
Phone 440-352-2500 · Fax 440-352-2554
Authorized official
Kelly Anne Malkamaki
Pharmacy Manager/Owner
4403522500
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