Provider Demographics
NPI:1326534850
Name:WHITE PIGEON PHARMACY LLC
Entity Type:Organization
Organization Name:WHITE PIGEON PHARMACY LLC
Other - Org Name:WHITE PIGEON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BIMAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-464-2384
Mailing Address - Street 1:410 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:49099-8794
Mailing Address - Country:US
Mailing Address - Phone:269-464-2384
Mailing Address - Fax:269-620-6109
Practice Address - Street 1:410 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:WHITE PIGEON
Practice Address - State:MI
Practice Address - Zip Code:49099-8794
Practice Address - Country:US
Practice Address - Phone:269-282-6779
Practice Address - Fax:269-620-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301011418333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326534850Medicaid
IN300023441Medicaid