# BRONSON VILLAGE DRUG, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Aurora Long Term Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699340539
- **Authorized official:** DR. JEFFREY ROBERT STULL PHARM.D. (PHARMACIST)
- **Authorized official phone:** (269) 668-1449

## Contact information

- **Practice address:** 25344 RED ARROW HWY, MATTAWAN, MI 49071-9742
- **Practice address phone:** (269) 668-1449
- **Practice address fax:** (888) 498-1343
- **Mailing address:** 25344 RED ARROW HWY, MATTAWAN, MI 49071-9742

## Taxonomy

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

## Other

- **Enumeration date:** 05/24/2021
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5315226820 | STATE OF MICHIGAN PHARMACY LICENSE | MI |