NPIMap

Organization Active NPI

Bronson Village Drug, Inc.

Doing business as Decatur Village Pharmacy

  • Community/Retail Pharmacy
  • Decatur, MI
National Provider Identifier
1558021931
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
BRONSON VILLAGE DRUG, INC.
Doing business as
Decatur Village Pharmacy
Practice address
108 E Delaware St
Decatur, MI 49045-1151
Phone
(269) 423-6770
NPI assigned
Dec 27, 2021
Last updated
Dec 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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

Authorized official

Name
Dr. Jeffrey Robert Stull, PHARM.D.
Title
Owner
Phone
(269) 655-4402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

108 E Delaware St
Decatur, MI 49045-1151

Mailing address

25344 Red Arrow Hwy
Mattawan, MI 49071-9742
Phone (269) 655-4402

Other names 1

  • Decatur Village Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Aurora Long Term Care4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

108 E Delaware St
Decatur, MI 49045
Phone (269) 423-6770

25344 Red Arrow Hwy
Mattawan, MI 49071
Phone (269) 668-1449

NPI Registry JSON

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

{
    "created_epoch": "1640563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640563200000",
    "number": "1558021931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25344 RED ARROW HWY",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490719742",
            "telephone_number": "269-655-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 E DELAWARE ST",
            "city": "DECATUR",
            "state": "MI",
            "postal_code": "490451151",
            "telephone_number": "269-423-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON VILLAGE DRUG, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A",
        "authorized_official_last_name": "STULL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-655-4402",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Decatur Village Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; 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.