Great Lakes Compounding Pharmacy
Pharmacy, Community/Retail Pharmacy in Grand Haven, MI. Organization (NPI-2).
Details
- NPI
- 1720272016
- Entity type
- Organization (NPI-2)
- Legal business name
- Great Lakes Compounding Pharmacy
- Organization subpart
- Yes
- Enumeration date
- Aug 30, 2007
- Last updated
- Jul 8, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 5301008607 | MI | Yes |
| 3336C0004X | Pharmacy, Compounding Pharmacy | – | – |
Practice location
1445 Sheldon Rd104a
Grand Haven, MI 49417-2480
Phone 616-842-1223 · Fax 616-842-0930
Mailing address
1445 Sheldon Rd104a
Grand Haven, MI 49417-2480
Phone 616-842-5193 · Fax 616-842-0930
Authorized official
Darcy Tussing
Dir Of Phrm
6168475230
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Community/Retail Pharmacy providers in Grand Haven, MI
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- Wal-Mart Stores East LPNPI 1134328610
All 5 Community/Retail Pharmacy providers in Grand Haven · All 892 providers in Grand Haven
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