Organization
BRONSON OUTPATIENT PHARMACY-PAW PAW
Active
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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