Healthcare Provider Details

I. General information

NPI: 1215190376
Provider Name (Legal Business Name): BENGRY PHARMACY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N MAIN ST
EVART MI
49631-9416
US

IV. Provider business mailing address

PO BOX 515
EVART MI
49631-0515
US

V. Phone/Fax

Practice location:
  • Phone: 231-734-2551
  • Fax: 231-734-5890
Mailing address:
  • Phone: 231-734-2551
  • Fax: 231-734-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301004005
License Number StateMI

VIII. Authorized Official

Name: ALAN BENGRY
Title or Position: PRESIDENT
Credential:
Phone: 231-734-2551