Bronson Village Drug, Inc.

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

BRONSON VILLAGE DRUG, INC.

Doing business as

Aurora Long Term Care

Practice address

25344 Red Arrow Hwy
Mattawan, MI 49071-9742

Phone

(269) 668-1449

Fax

(888) 498-1343

NPI assigned

May 24, 2021

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Pharmacist

Phone

(269) 668-1449

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Aurora Long Term Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

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.

• Bronson Village Drug, Inc.

  dba Decatur Village Pharmacy

  • Community/Retail Pharmacy
  • Decatur, MI
  • NPI 1558021931
  NPD tax ID
• Bronson Village Drug, Inc.

  dba Aurora Long Term Care - Traverse City

  • Long Term Care Pharmacy
  • Traverse City, MI
  • NPI 1639851116
  NPD tax ID
• Paw Paw Village Drug, Inc.

  dba Colon Village Drug

  • Community/Retail Pharmacy
  • Colon, MI
  • NPI 1922768308
  NPD tax ID

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1699340539",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25344 RED ARROW HWY",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490719742",
            "telephone_number": "269-668-1449",
            "fax_number": "888-498-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON VILLAGE DRUG, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-24",
        "last_updated": "2023-03-07",
        "certification_date": "2022-04-21",
        "status": "A",
        "authorized_official_last_name": "STULL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "269-668-1449",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MICHIGAN PHARMACY LICENSE",
            "identifier": "5315226820",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aurora Long Term Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Blaq Therapy
• Michael Robert Blostica
• Jennifer Lynn Bower, LMSW
• Brightside Consulting LLC (Brightside Counseling)
• Bronson Nursing and Rehabilitation Center (Bronson Commons)
• Christine V Call, REGISTERED NURSE
• Rebecca Carr, M.S. CCC-SLP
• Bailey Rose Caton, LAT, ATC
• Central Pharmacy-Mattawan LLC (Medicine Tree Pharmacy)
• Central Pharmacy-Mattawan LLC (Medicine Tree Pharmacy)

• Long Term Care Pharmacy in Mattawan, MI
• Providers in Mattawan, MI by specialty
• Long Term Care Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.