Healthcare Provider Details

I. General information

NPI: 1215136650
Provider Name (Legal Business Name): BMC PHARMACY WEST BLOOMFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ORCHARD LAKE RD SUITE 104
WEST BLOOMFIELD MI
48322-3405
US

IV. Provider business mailing address

6900 ORCHARD LAKE RD SUITE 104
WEST BLOOMFIELD MI
48322-3405
US

V. Phone/Fax

Practice location:
  • Phone: 248-855-5505
  • Fax: 248-855-5504
Mailing address:
  • Phone: 248-855-5505
  • Fax: 248-855-5504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008664
License Number StateMI

VIII. Authorized Official

Name: HEATHER THOMAS
Title or Position: MEMBER
Credential: RPH
Phone: 248-855-5505