Provider Demographics
NPI:1316008832
Name:MONITOR PHARMACY, INC.
Entity Type:Organization
Organization Name:MONITOR PHARMACY, INC.
Other - Org Name:MONITOR PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:BOUCKAERT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-684-2343
Mailing Address - Street 1:2981 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9267
Mailing Address - Country:US
Mailing Address - Phone:989-684-2343
Mailing Address - Fax:989-684-8642
Practice Address - Street 1:2981 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9267
Practice Address - Country:US
Practice Address - Phone:989-684-2343
Practice Address - Fax:989-684-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010009623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2306276OtherNCPDP
MI2512527Medicaid
MI2512527Medicaid