Organization
BRONSON VILLAGE DRUG, INC.
Active
Other names
Aurora Long Term Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY ROBERT STULL PHARM.D. (PHARMACIST)
(269) 668-1449
Entity
Organization
Contact information
Practice address
25344 RED ARROW HWY, MATTAWAN, MI 49071-9742
(269) 668-1449
(888) 498-1343
Mailing address
25344 RED ARROW HWY, MATTAWAN, MI 49071-9742
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315226820
STATE OF MICHIGAN PHARMACY LICENSE
MI
Enumeration date
05/24/2021
Last updated
03/07/2023
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