Organization
BRIDGEPORT PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND WILLIAM BOETTCHER JR. (REGISTERED PHARMACIST/IN CHARGE)
(989) 777-2900
Entity
Organization
Contact information
Practice address
6224 DIXIE HWY, BRIDGEPORT, MI 48722-9513
(989) 777-2900
(989) 777-4649
Mailing address
6224 DIXIE HWY, BRIDGEPORT, MI 48722-9513
(989) 777-2900
(989) 777-4649
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302025343
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2359998
—
MI
Enumeration date
10/28/2005
Last updated
02/29/2008
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