Individual
DR. THOMAS WALTER BODENDORFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
28053 SUNSET BLVD W, LATHRUP VILLAGE, MI 48076-7016
(248) 252-9720
Mailing address
28053 SUNSET BLVD W, LATHRUP VILLAGE, MI 48076-7016
(248) 252-9720
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
5302021966
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-2462706
LARA STATE MICHIGAN SMALL BUSINESS LICENSING
MI
Enumeration date
09/19/2022
Last updated
09/19/2022
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