Bridgeport Pharmacy INC

NPI #1114917242 in Bridgeport, Michigan

Provider Information

NPI Number: 1114917242
Entity Type: Organization
Organization Name: Bridgeport Pharmacy INC
Primary Specialty: Pharmacist
Enumeration Date: Oct 28, 2005
Last Updated: Feb 29, 2008

Practice Location

Address: 6224 DIXIE HWY
City: Bridgeport
State: Michigan
ZIP Code: 48722-9513
Phone: (989) 777-2900

Authorized Official

Name: MR. RAYMOND WILLIAM BOETTCHER JR.
Title: REGISTERED PHARMACIST/IN CHARGE
Phone: (989) 777-2900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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