Organization
BORMANS INC
Active
Other names
FARMER JACK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN KIJOWSKI (PHARMACY SPECIALIST)
(201) 571-8326
Entity
Organization
Contact information
Practice address
22385 PONTIAC TRL, SOUTH LYON, MI 48178-1646
(248) 446-3534
(248) 446-3519
Mailing address
22385 PONTIAC TRL, SOUTH LYON, MI 48178-1646
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
5301007095
MI
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2360624
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
4156313
—
MI
Enumeration date
07/13/2006
Last updated
09/11/2025
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