Healthcare Provider Details

I. General information

NPI: 1003807165
Provider Name (Legal Business Name): ANCHOR BAY PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/22/2020
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: 586-725-5610
Mailing address:
  • Phone: 586-725-3737
  • Fax: 586-725-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5301004295
License Number StateMI

VIII. Authorized Official

Name: MR. DENNIS BLOOM HALSTEAD
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 586-725-3737