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Organization

BRIDGEPORT PHARMACY, INC

Active
Parent organization
BRIDGEPORT PHARMACY INC
Other names
Bridgeport Home Medical Supply
Organization subpart
Yes

Provider details

NPI number
Legal business name
BRIDGEPORT PHARMACY INC
Authorized official
MRS. KAREN MARIE BOETTCHER (VICE PRESIDENT)
(989) 777-3286
Entity
Organization

Contact information

Practice address
6226 DIXIE HWY, BRIDGEPORT, MI 48722-9513
(989) 777-3286
(989) 777-3384
Mailing address
6226 DIXIE HWY, BRIDGEPORT, MI 48722-9513
(989) 777-3286
(989) 777-3384

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
10657A
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0G30386
BLUE CROSS BLUE SHIELD
MI
05
4226131
MI
Enumeration date
05/01/2006
Last updated
12/10/2010
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