Provider Demographics
NPI:1699543652
Name:GREAT LAKES VITALITY, LLC
Entity type:Organization
Organization Name:GREAT LAKES VITALITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-886-4178
Mailing Address - Street 1:1532 N OPDYKE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2686
Mailing Address - Country:US
Mailing Address - Phone:947-886-4178
Mailing Address - Fax:947-886-4655
Practice Address - Street 1:1532 N OPDYKE RD STE 700
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2686
Practice Address - Country:US
Practice Address - Phone:947-886-4178
Practice Address - Fax:947-886-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy