1639310600 NPI number — BIRDI, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639310600 NPI number — BIRDI, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIRDI, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BIRDI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639310600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43811 PLYMOUTH OAKS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48170-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-247-3479
Provider Business Mailing Address Fax Number:
877-395-4836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43811 PLYMOUTH OAKS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48170-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-247-3479
Provider Business Practice Location Address Fax Number:
877-395-4836
Provider Enumeration Date:
03/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BOSTWICK
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
248-380-2104

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X , with the licence number:  5301011074 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2119504 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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