Provider Demographics
NPI:1376145797
Name:PUROL, BERNARD JOHN
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:JOHN
Last Name:PUROL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 M 32 W
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-7730
Mailing Address - Country:US
Mailing Address - Phone:989-354-0731
Mailing Address - Fax:
Practice Address - Street 1:1180 M 32 W
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8105
Practice Address - Country:US
Practice Address - Phone:989-354-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist