Healthcare Provider Details

I. General information

NPI: 1265462238
Provider Name (Legal Business Name): NUGENT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6568 MAIN ST
CASEVILLE MI
48725
US

IV. Provider business mailing address

PO BOX 1405
CASEVILLE MI
48725-1405
US

V. Phone/Fax

Practice location:
  • Phone: 989-856-2900
  • Fax: 989-856-2051
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5301004412
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301004412
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAUL NUGENT
Title or Position: OWNER
Credential: RPH
Phone: 989-856-3811