Organization
INDIAN RIVER VILLAGE PHARMACY INC
Active
Other names
INDIAN RIVER VILLAGE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS BAHRA (PRESIDENT)
(231) 238-8911
Entity
Organization
Contact information
Practice address
6433 BARBARA ST, INDIAN RIVER, MI 49749-9010
(231) 238-8911
(231) 238-9190
Mailing address
PO BOX 2039, INDIAN RIVER, MI 49749-2039
(231) 238-8911
(231) 238-9190
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301003394
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2042171
PK
—
05
—
2534918
—
MI
Enumeration date
10/03/2006
Last updated
07/05/2016
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