Organization
BALD MOUNTAIN MEDICAL PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PIERRE BOUTRAS RPH (OWNER)
(248) 814-9814
Entity
Organization
Contact information
Practice address
1375 S LAPEER RD STE 103, LAKE ORION, MI 48360-1421
(248) 814-9814
(248) 814-9818
Mailing address
1375 S LAPEER RD STE 103, LAKE ORION, MI 48360-1421
(248) 814-9814
(248) 814-9818
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
5301007701
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2364862
NCPDP
MI
Enumeration date
08/22/2006
Last updated
08/22/2020
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