Provider Demographics
NPI:1265462238
Name:NUGENT PHARMACY INC
Entity type:Organization
Organization Name:NUGENT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-856-3811
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:CASEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48725-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6568 MAIN ST
Practice Address - Street 2:
Practice Address - City:CASEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48725
Practice Address - Country:US
Practice Address - Phone:989-856-2900
Practice Address - Fax:989-856-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0004X
MI5301004412332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265462238OtherOTHER COMMERCIAL IDENTIFIERS
MI1265462238Medicaid
MI540C210640OtherBCBS
2340797OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI2340797Medicaid
MI4812130001Medicare NSC