MEDICARE: BORDEN S FAMILY PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1033085220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDEN S FAMILY PHARMACY LLC

Provider Business Mailing Address
First Line	:	415 W VIENNA ST
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-1307
Country	:	US
Telephone Number	:	810-547-1278
Fax Number	:	810-547-1542

Provider Business Practice Location Address
First Line	:	415 W VIENNA ST
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-1307
Country	:	US
Telephone Number	:	810-547-1278
Fax Number	:	810-547-1542

Authorized Official
Title or Position	:	OWNER/PIC
Name	:	DR. KYLE V BROTHERTON
Credential	:	PHARMD.
Telephone Number	:	810-547-1278

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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