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General NPI Number Information
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NPI Number | 1861496333
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Entity Type | Organization
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Legal Business Name | BORDENS PHARMACY INC
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Dates
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Enumeration Date | 06/11/2005
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Last Update Date | 10/26/2013
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Provider Practice Location Address
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Address Line | 415 W VIENNA ST
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City | CLIO
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State | MI
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Zip | 48420-1307
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Country | US
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Telephone | 989-652-6945
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Fax | 989-652-6945
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Provider Business Mailing Address
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Address Line | 469 WICKSON DR
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City | FRANKENMUTH
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State | MI
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Zip | 48734-1144
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Country | US
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Telephone | 989-652-6945
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Fax | 989-652-6945
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Authorized Official
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Title or Position | OWNER AND PRES
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Name | WILLIAM DUDEWICZ
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Credential | RPH
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Telephone | 989-652-6945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008088
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License Number State | MI
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