Provider Demographics
NPI:1720406333
Name:BORGESS MEDICAL CENTER
Entity Type:Organization
Organization Name:BORGESS MEDICAL CENTER
Other - Org Name:BORGESS HEALTH PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKYLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:269-226-8336
Mailing Address - Street 1:3035 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4334
Mailing Address - Country:US
Mailing Address - Phone:269-565-9200
Mailing Address - Fax:
Practice Address - Street 1:3035 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4334
Practice Address - Country:US
Practice Address - Phone:269-656-9200
Practice Address - Fax:269-565-9210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010103843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy