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WILDERNS DRUG STORE NPI 1881669745


NPI Information

NPI: 1881669745
Provider Name: WILDERNS DRUG STORE
Classification: Pharmacy - 333600000X
Entity Type: Organization
Address:
123 LANSING ROAD
POTTERVILLE, MI
ZIP 48876
Phone: (517) 645-7680
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WILDERNS DRUG STORE is a pharmacy in Potterville, MI. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. WILDERNS DRUG STORE NPI is 1881669745. The provider is registered as an organization entity type.

The provider's business location address is:

123 LANSING ROAD
POTTERVILLE, MI
ZIP 48876
Phone: (517) 645-7680
Fax: (517) 645-7698

The provider's authorized official is Jeffrey Alan Wildern .
The authorized official title is President and has the following contact phone number (517) 645-7680.

The enumeration date for this NPI number is 2/22/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacy5301004387MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12340444MEDICAIDMICHIGAN
22340444OTHERMICHIGANBCBSM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.