BLUE WATER PHARMACY LLC (NPI# 1598092769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598092769 |
| Entity Type | Organization |
| Organization Name | BLUE WATER PHARMACY LLC |
| Other Organization Name | BLUE WATER PHARMACY |
| Practice Address |
1524 10th Street Port Huron MI 48060 |
| Practice Telephone | 8139823100 |
| Practice Fax Number | 8109823106 |
| Mailing Telephone | 8139823100 |
| Mailing Fax Number | 8109823106 |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2020-09-10 |
| Authorized Official Name | ALPESH PATEL (OWNER) |
| Authorized Official Telephone | 8133042221 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
5301009241 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2122665 | 01 |
| Other Name | Type Code |
|---|---|
| Benzer Pharmacy | Doing Business As Name - Organization |
| Blue Water Pharmacy | Doing Business As Name - Organization |
| Blue Water Pharmacy | Former Legal Business Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568091957 | Blue Water Pharmacy LLC | Pharmacy | 1524 10th Street, Port Huron, MI 48060 | 2020-04-07 |
| Street Address |
1524 10TH STREET |
| City | PORT HURON |
| State | MI |
| Zip Code | 48060 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568091957 | Blue Water Pharmacy LLC | Pharmacy | 1524 10th Street, Port Huron, MI 48060 | 2020-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740897297 | Casey Edward Bicker | Behavior Technician | 3245 Keewahdin Rd; Fort Gratiot, Mi 48059, Port Huron, MI 48060 | 2020-09-29 |
| 1962032078 | Brianne Salchert | Peer Specialist | 1170 Michigan Rd., Port Huron, MI 48060 | 2020-01-17 |
| 1982123006 | Kenneth Shine Heuvelman | Counselor | 3522 Holland Park Ln, Port Huron, MI 48060 | 2017-09-11 |
| 1346767506 | Kelly Baker | Social Worker | 520 Superior St., Port Huron, MI 48060 | 2017-08-28 |
| 1326418609 | Jean Burleigh | Chore Provider | 614 Staton, Port Huron, MI 48060 | 2015-09-30 |
| 1205242161 | Lisa Gray | Counselor | 2885 W Rick Dr, Port Huron, MI 48060 | 2014-07-10 |
| 1861758880 | Aaron Overly | Surgery | 2609 Electric Ave Ste B&, Port Huron, MI 48060 | 2012-04-03 |
| 1942591508 | S Akram Ali | Surgery | 3270 Waldheim Dr, Port Huron, MI 48060 | 2011-04-29 |
| 1417258179 | Nicholas Alexander Tobianski | Physician Assistant | 3550 Pine Grove Avenue, Port Huron, MI 48060 | 2010-11-11 |
| 1245566702 | David Burnham I | Adult Companion | 3111 Electric Ave., Port Huron, MI 48060 | 2009-10-19 |
| Find all providers in zip 48060 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| 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: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346349644 | Woodward Detroit Cvs, L.L.C. | Pharmacy | 940 Lapeer Ave, Port Huron, MI 48060-4414 | 2006-09-22 |
| 1417069360 | Woodward Detroit Cvs, L.L.C. | Pharmacy | 3530 Pine Grove Ave, Port Huron, MI 48060-1944 | 2006-08-31 |
| 1538187448 | Ehardt's Advanced Care Pharmacy | Pharmacy | 208 Huron Ave, Port Huron, MI 48060-3822 | 2006-07-18 |
| 1497791313 | Genoa Healthcare, LLC | Pharmacy | 3111 Electric Ave, Port Huron, MI 48060-8127 | 2006-06-20 |
| 1629341102 | Port Huron Pharmacy, LLC | Pharmacy | 515 10th St, Port Huron, MI 48060-4404 | 2012-02-15 |
| 1306142914 | Downriver Community Services Inc | Pharmacy | 1011 Military St, Port Huron, MI 48060-5416 | 2011-01-28 |
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| 1225645781 | Good Choice Pharmacy LLC | Pharmacy | 6750 E 10 Mile Rd, Center Line, MI 48015-1166 | 2020-09-29 |
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| 1023621190 | Azam Mohsen Mesleh | Pharmacy | 6811 Theisen St, Dearborn, MI 48126-1927 | 2020-08-28 |
| 1821606310 | S&k Pharmacy Inc. | Pharmacy | 1916 Davison Rd, Flint, MI 48506-4423 | 2020-07-21 |
| Find all providers with the same taxonomy | ||||
| City | PORT HURON |
| Zip Code | 48060 |
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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.