BALD MOUNTAIN MEDICAL PHARMACY (NPI# 1588770606) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588770606 |
| Entity Type | Organization |
| Organization Name | BALD MOUNTAIN MEDICAL PHARMACY |
| Practice Address |
1375 S Lapeer Rd Ste 103 Lake Orion MI 48360-1421 |
| Practice Telephone | 2488149814 |
| Practice Fax Number | 2488149818 |
| Mailing Telephone | 2488149814 |
| Mailing Fax Number | 2488149818 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. PIERRE BOUTRAS (OWNER) |
| Authorized Official Telephone | 2488149814 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | 5301007701 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | NCPDP | 2364862 | 01 |
| Street Address |
1375 S LAPEER RD STE 103 |
| City | LAKE ORION |
| State | MI |
| Zip Code | 48360-1421 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619469889 | Heather Meharg | Pharmacist | 1375 S Lapeer Rd Ste 103, Lake Orion, MI 48360-1421 | 2018-06-04 |
| 1962941740 | Falcon Medical Pharmacy LLC | Pharmacy | 1375 S Lapeer Rd Ste 103, Lake Orion, MI 48360-1421 | 2017-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124409446 | Kyle Vires | Licensed Practical Nurse | 2271 Geyer Ct, Lake Orion, MI 48360 | 2015-06-11 |
| 1871931592 | Ihsan Asbahi | Anesthesiology | 1234 S Lapeer Rd, Lake Orion, MI 48360 | 2013-06-05 |
| 1205119567 | Michigan Bone and Joint Center | Orthopaedic Surgery | 1251 S. Lapeer Rd., Suite #102, Lake Orion, MI 48360 | 2011-09-23 |
| 1629226139 | Travis L Summerville | Physical Therapist | 1298 Walloon Way, Lake Orion, MI 48360 | 2008-09-09 |
| 1982878609 | Audrey Vizzaccaro | Physician Assistant | 1261 South Lapeer Rd, Ste 201, Lake Orion, MI 48360 | 2008-04-14 |
| 1881872265 | H & L Drugs Inc | Durable Medical Equipment & Medical Supplies | 1455 S Lapeer, Suite 101, Lake Orion, MI 48360 | 2008-02-07 |
| 1598952129 | Oakland Psychological Clinic, P.C. | Counselor | 1455 S Lapeer Rd Ste 175n, Lake Orion, MI 48360 | 2007-09-27 |
| 1700098704 | Laura Elizabeth Salome | Audiologist | 1176 S. Lapeer Rd, Lake Orion, MI 48360 | 2007-05-04 |
| 1780743658 | Frank James Iulianelli | Chiropractor | 2523 South Lapeer Road, Lake Orion, MI 48360 | 2006-12-07 |
| 1942377122 | James C Komendera Dds PC | Dentist | 1135 S Lapeer Rd, Lake Orion, MI 48360 | 2006-11-30 |
| Find all providers in zip 48360 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497786487 | Kmart of Michigan Inc | Pharmacy | 1025 S Lapeer Rd, Lake Orion, MI 48360-1429 | 2006-07-06 |
| 1962941740 | Falcon Medical Pharmacy LLC | Pharmacy | 1375 S Lapeer Rd Ste 103, Lake Orion, MI 48360-1421 | 2017-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961763 | Dustyn Daniel Thoney | Pharmacy | 530 Harding Ave, Iron River, MI 49935-2265 | 2020-10-27 |
| 1497355697 | Katherine Jane Cybulski | Pharmacy | 1310 Waukazoo St, Hastings, MI 49058-9559 | 2020-10-27 |
| 1043836042 | Hanan Pharmacy LLC | Pharmacy | 4600 E 14 Mile Road, Suite 2, Warren, MI 48092-1057 | 2020-06-25 |
| 1770104192 | Hazelwood Pharmacy LLC | Pharmacy | 624 E 9 Mile Rd Ste C, Hazel Park, MI 48030-1842 | 2020-04-27 |
| 1457980609 | Berkley Pharmacy LLC | Pharmacy | 28577 Schoenherr Road, Warren, MI 48088 | 2020-04-08 |
| 1669012316 | Warriors Pharmacy, Inc. | Pharmacy | 5265 Anthony Wayne Dr, Detroit, MI 48202-3947 | 2020-01-10 |
| 1457996662 | Sunrise Pharmacy, LLC | Pharmacy | 989 University Dr Ste 104, Pontiac, MI 48342-1885 | 2019-11-12 |
| 1447894019 | Nova Pharmacy | Pharmacy | 15140 Levan Rd, Suite 40, Livonia, MI 48154 | 2019-11-06 |
| 1912541673 | Wayne Pharma | Pharmacy | 974 Ford Ave, Wyandotte, MI 48192 | 2019-11-05 |
| 1639720667 | Grand Haven Pharmacy LLC | Pharmacy | 930 John R Rd Ste Pharmacy, Troy, MI 48083-4316 | 2019-09-20 |
| Find all providers with the same taxonomy | ||||
| City | LAKE ORION |
| Zip Code | 48360 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.