Organization
BONNE SANTE COMPOUNDING PHARMACY LLC
Active
Other names
Bonne Sante Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
KSHAMA JAYASURIYA (R.PH)
(248) 792-2920
Entity
Organization
Contact information
Practice address
36700 WOODWARD AVE, SUITE 105, BLOOMFIELD HILLS, MI 48304-0926
(249) 792-2920
(248) 792-2865
Mailing address
36700 WOODWARD AVE, SUITE 105, BLOOMFIELD HILLS, MI 48304-0926
(249) 792-2920
(248) 792-2865
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301010444
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2146643
PK
—
Enumeration date
06/24/2014
Last updated
11/13/2014
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