Organization
WILDERNS DRUG STORE
Active
Other names
Wilderns Drug Store
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY WILDERN (OWNER)
(517) 543-0978
Entity
Organization
Contact information
Practice address
201 S COCHRAN AVE, CHARLOTTE, MI 48813-1550
(517) 432-0830
(517) 543-9087
Mailing address
201 S COCHRAN, CHARLOTTE, MI 48813
(517) 543-0978
(517) 541-1548
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
530100084
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2520171
—
MI
01
—
540B305019
BCBSM
MI
Enumeration date
02/08/2006
Last updated
09/17/2010
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