Organization
BLUE WATER PHARMACY LLC
Active
Other names
Blue Water Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MANISH PATEL (OWNER)
(813) 304-2221
Entity
Organization
Contact information
Practice address
1524 10TH STREET, PORT HURON, MI 48060
(813) 982-3100
(810) 982-3106
Mailing address
1524 10TH STREET, PORT HURON, MI 48060
(813) 982-3100
(810) 982-3106
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301009241
MI
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122665
PK
—
Enumeration date
11/10/2009
Last updated
06/19/2023
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