MEDICARE: BORDENS PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301008088	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2040754	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861496333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORDENS PHARMACY INC

Provider Business Mailing Address
First Line	:	469 WICKSON DR
Second Line	:
City	:	FRANKENMUTH
State	:	MI
Zip	:	48734-1144
Country	:	US
Telephone Number	:	989-652-6945
Fax Number	:	989-652-6945

Provider Business Practice Location Address
First Line	:	415 W VIENNA ST
Second Line	:
City	:	CLIO
State	:	MI
Zip	:	48420-1307
Country	:	US
Telephone Number	:	989-652-6945
Fax Number	:	989-652-6945

Authorized Official
Title or Position	:	OWNER AND PRES
Name	:	WILLIAM DUDEWICZ
Credential	:	RPH
Telephone Number	:	989-652-6945

Provider Enumeration Date	:	06/11/2005
Last Update Date	:	10/26/2013

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