Healthcare Provider Details

I. General information

NPI: 1568487122
Provider Name (Legal Business Name): BORMANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23101 JOHN R RD
HAZEL PARK MI
48030-1475
US

IV. Provider business mailing address

23101 JOHN R RD
HAZEL PARK MI
48030-1475
US

V. Phone/Fax

Practice location:
  • Phone: 248-399-5208
  • Fax: 248-399-4375
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301005870
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SUSAN KIJOWSKI
Title or Position: PHARMACY SPECIALIST
Credential:
Phone: 201-571-8326