| Organization Name: | LAKELAND IMMEDIATE CARE CENTER |
| NPI Number: | 1114328614 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY MIDDLETON (CEO) |
| Mailing Address: | 261 M 62 Cassopolis |
| State: | MI US |
| Postal Code: | 490311034 |
| Phone Number: | 2692288505 |
| Fax Number: | 2694451911 |
| NPI Enumeration Date: | 09/16/2014 |
| NPI Last Update Date: | 04/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Clinic Pharmacy |
| Taxonomy Definition: | A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |