Organization
INDIAN RIVER VILLAGE PHARMACY INC
Active
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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