Provider Demographics
NPI:1376096552
Name:BPI PHARMACY INC
Entity Type:Organization
Organization Name:BPI PHARMACY INC
Other - Org Name:BUNTES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAREDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-891-1116
Mailing Address - Street 1:115 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1735
Mailing Address - Country:US
Mailing Address - Phone:616-772-4685
Mailing Address - Fax:616-772-9526
Practice Address - Street 1:115 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1735
Practice Address - Country:US
Practice Address - Phone:616-772-4685
Practice Address - Fax:616-772-9526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010110473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162244OtherPK
MI1376096552Medicaid