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General NPI Number Information
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NPI Number | 1669901815
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Entity Type | Organization
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Legal Business Name | BRIDGE HEALTHCARE PHARMACY LLC
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 06/09/2017
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Provider Practice Location Address
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Address Line | 658 E. MAIN ST SUITE 1
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City | CENTREVILLE
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State | MI
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Zip | 49032
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Country | US
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Telephone | 269-467-3510
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Fax | 269-467-3515
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Provider Business Mailing Address
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Address Line | P.O. BOX 22
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City | NAZARETH
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State | MI
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Zip | 49074
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Country | US
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Telephone | 269-467-3510
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Fax | 269-467-3515
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Authorized Official
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Title or Position | OWNER/PIC
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Name | MR. MICHAEL DABAJA
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Credential |
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Telephone | 269-467-3510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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