Provider Demographics
NPI:1205229408
Name:BRONSON PHARMACY INC
Entity Type:Organization
Organization Name:BRONSON PHARMACY INC
Other - Org Name:BRONSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-670-3531
Mailing Address - Street 1:150 N HATHAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-6739
Mailing Address - Country:US
Mailing Address - Phone:352-450-7738
Mailing Address - Fax:352-486-9061
Practice Address - Street 1:150 N HATHAWAY AVE
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-6739
Practice Address - Country:US
Practice Address - Phone:352-450-7738
Practice Address - Fax:352-486-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH292043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151619OtherPK