GREAT LAKES RPH (NPI# 1023017456) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023017456 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES RPH |
| Other Organization Name | WEICK'S PHARMACY |
| Practice Address |
71 124th Ave Shelbyville MI 49344-9772 |
| Mailing Address |
71 124th Ave Po Box 53 Shelbyville MI 49344-9772 |
| Practice Telephone | 2696727774 |
| Mailing Telephone | 2696727774 |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. MICHAEL A HOLTZ (PHARMACIST/OWNER) |
| Authorized Official Telephone | 2696727774 |
| Authorized Official Credential | R.PH. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | NCPDP # | 2343250 | 01 |
| Other Name | Type Code |
|---|---|
| WEICK'S PHARMACY | Doing Business As Name - Organization |
| Street Address |
71 124TH AVE |
| City | SHELBYVILLE |
| State | MI |
| Zip Code | 49344-9772 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902970668 | Great Lakes R.ph. Corp | Durable Medical Equipment & Medical Supplies | 71 124th Ave, Shelbyville, MI 49344 | 2006-11-17 |
| 1679573364 | Michael A Holtz | Pharmacist | 71 124th Ave, Shelbyville, MI 49344-9772 | 2005-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972670248 | Daniel Joe Lavengood | Chiropractor | 11925 Marsh Rd, Shelbyville, MI 49344 | 2006-11-29 |
| 1619328879 | Kelsey Mosher | Pharmacist | 2880 Mission Dr, Shelbyville, MI 49344 | 2016-06-28 |
| 1871030122 | Bobbi Keyzer | Registered Nurse | 972 129th Ave, Shelbyville, MI 49344-9509 | 2017-01-25 |
| 1952685588 | Match-e-be-nash-she-wish Band of Pottawatomi Indians | Clinic/Center | 2880 Mission Dr, Shelbyville, MI 49344-9580 | 2011-09-30 |
| 1689232241 | Match-e-be-nash-she-wish Band of Pottawatomi Indians | Pharmacy | 2880 Mission Dr, Shelbyville, MI 49344-9580 | 2019-05-30 |
| 1578961868 | Misty Wuis | Licensed Practical Nurse | 2423 Pearl St, Shelbyville, MI 49344-9700 | 2014-12-18 |
| 1750731972 | Elizabeth Spaulding | Technician, Other | 2535 7th St Apt 6, Shelbyville, MI 49344-9761 | 2016-06-18 |
| 1053941088 | Camille Woolf Irvine | Dietitian, Registered | 5419 Fawn Lake Dr, Shelbyville, MI 49344-9780 | 2020-01-17 |
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396283073 | Rx Stores LLC | Pharmacy | 415 N Cedar St, Shelbyville, IL 62565-1245 | 2017-02-02 |
| 1194064949 | Eumedics Health, LLC | Pharmacy | 223 Saint Regis Dr, Shelbyville, KY 40065-6317 | 2013-02-13 |
| 1710070156 | Medworks Inc | Pharmacy | 1412 Miller Ave, Shelbyville, IN 46176-3135 | 2006-09-30 |
| 1770517419 | Kroger Limited Partnership I | Pharmacy | 1010 N Main St, Shelbyville, TN 37160-2308 | 2006-07-10 |
| 1689232241 | Match-e-be-nash-she-wish Band of Pottawatomi Indians | Pharmacy | 2880 Mission Dr, Shelbyville, MI 49344-9580 | 2019-05-30 |
| 1356330690 | Medworks, Inc | Pharmacy | 30 W Rampart St, Suite 140, Shelbyville, IN 46176-8846 | 2005-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961763 | Dustyn Daniel Thoney | Pharmacy | 530 Harding Ave, Iron River, MI 49935-2265 | 2020-10-27 |
| 1497355697 | Katherine Jane Cybulski | Pharmacy | 1310 Waukazoo St, Hastings, MI 49058-9559 | 2020-10-27 |
| 1043836042 | Hanan Pharmacy LLC | Pharmacy | 4600 E 14 Mile Road, Suite 2, Warren, MI 48092-1057 | 2020-06-25 |
| 1770104192 | Hazelwood Pharmacy LLC | Pharmacy | 624 E 9 Mile Rd Ste C, Hazel Park, MI 48030-1842 | 2020-04-27 |
| 1457980609 | Berkley Pharmacy LLC | Pharmacy | 28577 Schoenherr Road, Warren, MI 48088 | 2020-04-08 |
| 1669012316 | Warriors Pharmacy, Inc. | Pharmacy | 5265 Anthony Wayne Dr, Detroit, MI 48202-3947 | 2020-01-10 |
| 1457996662 | Sunrise Pharmacy, LLC | Pharmacy | 989 University Dr Ste 104, Pontiac, MI 48342-1885 | 2019-11-12 |
| 1447894019 | Nova Pharmacy | Pharmacy | 15140 Levan Rd, Suite 40, Livonia, MI 48154 | 2019-11-06 |
| 1912541673 | Wayne Pharma | Pharmacy | 974 Ford Ave, Wyandotte, MI 48192 | 2019-11-05 |
| 1639720667 | Grand Haven Pharmacy LLC | Pharmacy | 930 John R Rd Ste Pharmacy, Troy, MI 48083-4316 | 2019-09-20 |
| Find all providers with the same taxonomy | ||||
| City | SHELBYVILLE |
| Zip Code | 49344 |
Please comment or provide details below to improve the information on GREAT LAKES RPH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.