Provider Demographics
NPI:1225189103
Name:BOSLEY PHARMACY NO. 2 INC
Entity Type:Organization
Organization Name:BOSLEY PHARMACY NO. 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:JASPERSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-945-3429
Mailing Address - Street 1:118 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1826
Mailing Address - Country:US
Mailing Address - Phone:269-945-3429
Mailing Address - Fax:269-945-0050
Practice Address - Street 1:118 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1826
Practice Address - Country:US
Practice Address - Phone:269-945-3429
Practice Address - Fax:269-945-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301001810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherPHARMACY