Provider Demographics
NPI:1861496333
Name:BORDENS PHARMACY INC
Entity Type:Organization
Organization Name:BORDENS PHARMACY INC
Other - Org Name:BORDENS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-652-6945
Mailing Address - Street 1:469 WICKSON DR
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1144
Mailing Address - Country:US
Mailing Address - Phone:989-652-6945
Mailing Address - Fax:989-652-6945
Practice Address - Street 1:415 W VIENNA ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1307
Practice Address - Country:US
Practice Address - Phone:989-652-6945
Practice Address - Fax:989-652-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-11
Last Update Date:2013-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010080883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2040754OtherPK
MI2313245Medicaid
MI2501793Medicaid
5516390001Medicare NSC