=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083639645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BORMANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 S TELEGRAPH RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-243-1182
-----------------------------------------------------
Fax | 734-243-1538
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 S TELEGRAPH RD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY SPECIALIST
-----------------------------------------------------
Name | SUSAN KIJOWSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-571-8326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 5301007513
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------