NPIMap

Organization Active NPI

Bronson Outpatient Pharmacy-Paw Paw

  • Community/Retail Pharmacy
  • Paw Paw, MI
National Provider Identifier
1639370430
Registry record updated Jan 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301008566 Issued in MI
Legal business name
BRONSON OUTPATIENT PHARMACY-PAW PAW
Practice address
451 Health Pkwy
Paw Paw, MI 49079-8242
Phone
(269) 655-3095
Fax
(269) 655-0764
NPI assigned
May 30, 2007
Last updated
Jan 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2008

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

Authorized official

Name
Holly Wagner
Title
Pharmacy Manager
Phone
(269) 341-6244

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301008566 MI Primary

Addresses

Primary practice location

451 Health Pkwy
Paw Paw, MI 49079-8242

Mailing address

451 Health Pkwy
Paw Paw, MI 49079-8242

Other identifiers 1

IdentifierTypeStateIssuer
2368276OtherOTHER ID NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Mitchell C MD9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1639370430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 HEALTH PKWY",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490798242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 HEALTH PKWY",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490798242",
            "telephone_number": "269-655-3095",
            "fax_number": "269-655-0764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON OUTPATIENT PHARMACY-PAW PAW",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "269-341-6244"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2368276",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paw Paw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.