# BLUE WATER PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Blue Water Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568091957
- **Authorized official:** ALPESH PATEL (OWNER)
- **Authorized official phone:** (813) 304-2221

## Contact information

- **Practice address:** 1524 10TH STREET, PORT HURON, MI 48060
- **Practice address phone:** (810) 982-3100
- **Practice address fax:** (810) 982-3106
- **Mailing address:** 1524 10TH STREET, PORT HURON, MI 48060
- **Mailing address phone:** (813) 304-2221

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 04/07/2020
- **Last updated:** 08/25/2020