Provider Demographics
NPI:1558603902
Name:BINGHAM PHARMACY LLC
Entity Type:Organization
Organization Name:BINGHAM PHARMACY LLC
Other - Org Name:BINGHAM PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEETIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-309-8064
Mailing Address - Street 1:7825 N DIXIE HWY
Mailing Address - Street 2:SUITE#105
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9750
Mailing Address - Country:US
Mailing Address - Phone:734-789-8957
Mailing Address - Fax:
Practice Address - Street 1:7825 N DIXIE HWY STE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-9750
Practice Address - Country:US
Practice Address - Phone:734-789-8957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
MI53010100563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2377869OtherNCPDP PROVIDER IDENTIFICATION NUMBER