Healthcare Provider Details

I. General information

NPI: 1831495597
Provider Name (Legal Business Name): ANCHOR BAY PHARAMCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51006 WASHINGTON ST
NEW BALTIMORE MI
48047-2157
US

IV. Provider business mailing address

51006 WASHINGTON ST
NEW BALTIMORE MI
48047-2157
US

V. Phone/Fax

Practice location:
  • Phone: 586-725-3737
  • Fax: 576-725-5610
Mailing address:
  • Phone: 586-725-3737
  • Fax: 576-725-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5301004295
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301004295
License Number StateMI

VIII. Authorized Official

Name: MR. DENNIS B. HALSTEAD
Title or Position: PHARMACIST IN CHARGE
Credential: R.PH.
Phone: 586-725-3737