Provider Demographics
NPI:1538674163
Name:MIDMICHIGAN RX SERVICES LLC
Entity Type:Organization
Organization Name:MIDMICHIGAN RX SERVICES LLC
Other - Org Name:BRIDGEPORT RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VILPESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-777-2900
Mailing Address - Street 1:6224 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48722-9513
Mailing Address - Country:US
Mailing Address - Phone:989-777-2900
Mailing Address - Fax:989-777-4649
Practice Address - Street 1:6224 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9513
Practice Address - Country:US
Practice Address - Phone:989-777-2900
Practice Address - Fax:989-777-4649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy