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Bormans Inc

Organization Active NPI Community/Retail Pharmacy · Detroit, MI

NPI 1477578029 · NPPES record last updated Sep 11, 2025

Key facts

NPI
1477578029
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
Legal business name
BORMANS INC
Practice address
19195 Livernois Ave
Detroit, MI 48221-1715
Phone
(313) 862-8017
Fax
(313) 862-2443
NPI assigned
Jul 13, 2006
Organization subpart
No

Authorized official

Name
Susan Kijowski
Title
Pharmacy Specialist
Phone
(201) 571-8326

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Bormans Inc (57 organizations share this tax ID)

Locations

19195 Livernois Ave
Detroit, MI 48221
Phone (313) 862-8017

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 5301004524 MI
Community/Retail Pharmacy 3336C0003X Yes

Addresses

Primary practice location

19195 Livernois Ave
Detroit, MI 48221-1715

Mailing address

19195 Livernois Ave
Detroit, MI 48221-1715

Other identifiers

IdentifierTypeStateIssuer
2337409OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2798059MedicaidMI

Other names

  • FARMER JACK PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 11, 2025.

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1477578029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19195 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482211715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19195 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482211715",
            "telephone_number": "313-862-8017",
            "fax_number": "313-862-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BORMANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "KIJOWSKI",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PHARMACY SPECIALIST",
        "authorized_official_telephone_number": "201-571-8326"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301004524",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2337409",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2798059",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FARMER JACK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

All providers in Detroit, MI · Community/Retail Pharmacy in Michigan

Sources for this page

Verify at the official NPI Registry.