NPIMap

Organization Active NPI

Bridgeport Pharmacy Inc

  • Pharmacist
  • Bridgeport, MI
National Provider Identifier
1114917242
Registry record updated Feb 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302025343 Issued in MI
Legal business name
BRIDGEPORT PHARMACY INC
Practice address
6224 Dixie Hwy
Bridgeport, MI 48722-9513
Phone
(989) 777-2900
Fax
(989) 777-4649
NPI assigned
Oct 28, 2005
Last updated
Feb 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2008

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

Authorized official

Name
Mr. Raymond William Boettcher Jr.
Title
Registered Pharmacist/in Charge
Phone
(989) 777-2900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X 5302025343 MI Primary

Addresses

Primary practice location

6224 Dixie Hwy
Bridgeport, MI 48722-9513

Mailing address

6224 Dixie Hwy
Bridgeport, MI 48722-9513
Phone (989) 777-2900

National Provider Directory

National Provider Directory

Locations

6224 Dixie Hwy
Bridgeport, MI 48722
Phone (989) 777-2900

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204243200000",
    "number": "1114917242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6224 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229513",
            "telephone_number": "989-777-2900",
            "fax_number": "989-777-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6224 DIXIE HWY",
            "city": "BRIDGEPORT",
            "state": "MI",
            "postal_code": "487229513",
            "telephone_number": "989-777-2900",
            "fax_number": "989-777-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2008-02-29",
        "status": "A",
        "authorized_official_last_name": "BOETTCHER",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "REGISTERED PHARMACIST/IN CHARGE",
        "authorized_official_telephone_number": "989-777-2900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302025343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; 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.