Healthcare Provider Details

I. General information

NPI: 1508103292
Provider Name (Legal Business Name): BSW PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34841 VETERANS PLZ
WAYNE MI
48184-1733
US

IV. Provider business mailing address

34841 VETERANS PLZ
WAYNE MI
48184-1733
US

V. Phone/Fax

Practice location:
  • Phone: 734-728-8306
  • Fax: 734-728-8506
Mailing address:
  • Phone: 734-728-8306
  • Fax: 734-728-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009995
License Number StateMI

VIII. Authorized Official

Name: DOMINICK RUTHERFORD
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 734-728-8306