Provider Demographics
NPI:1639310600
Name:BIRDI, INC
Entity Type:Organization
Organization Name:BIRDI, INC
Other - Org Name:BIRDI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:248-380-2104
Mailing Address - Street 1:43811 PLYMOUTH OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2539
Mailing Address - Country:US
Mailing Address - Phone:855-247-3479
Mailing Address - Fax:877-395-4836
Practice Address - Street 1:43811 PLYMOUTH OAKS BLVD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2539
Practice Address - Country:US
Practice Address - Phone:855-247-3479
Practice Address - Fax:877-395-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010110743336M0002X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119504OtherPK