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Organization

BRONSON OUTPATIENT PHARMACY-PAW PAW

Active
Organization subpart
No

Provider details

NPI number
Authorized official
HOLLY WAGNER (PHARMACY MANAGER)
(269) 341-6244
Entity
Organization

Contact information

Practice address
451 HEALTH PKWY, PAW PAW, MI 49079-8242
(269) 655-3095
(269) 655-0764
Mailing address
451 HEALTH PKWY, PAW PAW, MI 49079-8242

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008566
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2368276
OTHER ID NUMBER
Enumeration date
05/30/2007
Last updated
01/08/2008
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