Provider Demographics
NPI:1689006918
Name:BOSLEY PHARMACY NO. 2 INC
Entity Type:Organization
Organization Name:BOSLEY PHARMACY NO. 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:269-945-3429
Mailing Address - Street 1:118 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1826
Mailing Address - Country:US
Mailing Address - Phone:269-945-3429
Mailing Address - Fax:269-945-0050
Practice Address - Street 1:118 S. JEFFERSON ST.
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058
Practice Address - Country:US
Practice Address - Phone:269-945-3429
Practice Address - Fax:269-945-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022795333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy