Thomas Walter Bodendorfer, PHARMD

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

5302021966 Issued in MI

Practice address

28053 Sunset Blvd W
Lathrup Village, MI 48076-7016

Phone

(248) 252-9720

NPI assigned

Sep 19, 2022

Last updated

Sep 19, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1663545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1104548999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28053 SUNSET BLVD W",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480767016",
            "telephone_number": "248-252-9720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28053 SUNSET BLVD W",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480767016",
            "telephone_number": "248-252-9720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODENDORFER",
        "first_name": "THOMAS",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-19",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "MI",
            "license": "5302021966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LARA STATE MICHIGAN SMALL BUSINESS LICENSING",
            "identifier": "87-2462706",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beneficent Wellness L.L.C
• Hussein Beydoun, OWNER
• Kertia Libretto Black, MD
• Gary P Blackburn, D.C.
• Nicola Thomas Bleggi, D.C.
• Jamie Lorraine Bodenhafer, L.M.S.W.
• Ronald Michael Boggs, DC
• Robert Boykin, D.C
• Basel Brikho, MD
• Erika L Bunkley, HIS

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Lathrup Village, MI
• Providers in Lathrup Village, MI by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.