Healthcare Provider Details

I. General information

NPI: 1619253093
Provider Name (Legal Business Name): DAVID W BODE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S US HIGHWAY 131
THREE RIVERS MI
49093-8833
US

IV. Provider business mailing address

301 S US HIGHWAY 131
THREE RIVERS MI
49093-8833
US

V. Phone/Fax

Practice location:
  • Phone: 269-279-9066
  • Fax:
Mailing address:
  • Phone: 269-279-9066
  • Fax: 269-279-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302037009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: