NPIMap

Organization Active NPI

Blue Water Pharmacy LLC

  • Long Term Care Pharmacy
  • Port Huron, MI
National Provider Identifier
1568091957
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
BLUE WATER PHARMACY LLC
Practice address
1524 10TH Street
Port Huron, MI 48060
Phone
(810) 982-3100
Fax
(810) 982-3106
NPI assigned
Apr 7, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Authorized official

Name
Alpesh Patel
Title
Owner
Phone
(813) 304-2221

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

1524 10TH Street
Port Huron, MI 48060

Mailing address

1524 10TH Street
Port Huron, MI 48060
Phone (813) 304-2221

Other names 1

  • Blue Water Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Blue Water Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1524 10th St
Port Huron, MI 48060
Phone (810) 982-3100

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598313600000",
    "number": "1568091957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 10TH STREET",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "813-304-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 10TH STREET",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-982-3100",
            "fax_number": "810-982-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-07",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "ALPESH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-304-2221"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Water Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; 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.