National Provider Identifier Database

WILDERNS DRUG STORE
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.


Contact Information

WILDERNS DRUG STORE
123 LANSING ROAD
POTTERVILLE, MI48876
Phone: 517-645-7680
Fax: 517-645-7698
Website:
Specialty Taxonomy Code
* Pharmacy 333600000X

* Indicates primary specialty

NPI Profile & details for WILDERNS DRUG STORE

NPI Number 1881669745
Legal business name
LBN
WILDERNS DRUG STORE
Authorized official JEFFREY WILDERN - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 02/22/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • MI License #: 5301004387
  • MI Medicaid: 2340444
  • MI Other: 2340444 BCBSM

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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