Organization
BRONSON VILLAGE DRUG, INC.
Active
Other names
Decatur Village Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY ROBERT STULL PHARM.D. (OWNER)
(269) 655-4402
Entity
Organization
Contact information
Practice address
108 E DELAWARE ST, DECATUR, MI 49045-1151
(269) 423-6770
Mailing address
25344 RED ARROW HWY, MATTAWAN, MI 49071-9742
(269) 655-4402
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5301010068
PHARMACY LICENSE
MI
Enumeration date
12/27/2021
Last updated
12/27/2021
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