Active NPI
Elliot Richard Anderson, PHARMD
- Pharmacist
- Niles, MI
National Provider Identifier
1003215203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302039877
- Practice address
- 1951 Oak St
Niles, MI 49120-3738 - Phone
- (269) 665-8900
- NPI assigned
- Aug 14, 2014
- Last updated
- Mar 9, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 26025937A | IN | |
| Pharmacist | 183500000X | 5302039877 | MI | Primary |
Addresses
Primary practice location
1951 Oak St
Niles, MI 49120-3738
Mailing address
1951 Oak St
Niles, MI 49120-3738
Phone (269) 665-8900
Other practice location 1
261 M 62
Cassopolis, MI 49031-1034
Phone (269) 228-8505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26025937A | IN | MD | Pharmacist |
| 5302039877 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of Michigan Inc | Past | Accepting new patients | |
| Rite Aid of Michigan Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Rite Aid Pharmacy 04238
- Community/Retail Pharmacy
- Bridgman, MI
- NPI 1013026582
-
dba Rite Aid Pharmacy 04068
- Community/Retail Pharmacy
- Washington, MI
- NPI 1619117405
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646784000000",
"number": "1003215203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1951 OAK ST",
"city": "NILES",
"state": "MI",
"postal_code": "491203738",
"telephone_number": "269-665-8900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1951 OAK ST",
"city": "NILES",
"state": "MI",
"postal_code": "491203738",
"telephone_number": "269-665-8900"
}
],
"practiceLocations": [
{
"address_1": "261 M 62",
"address_purpose": "LOCATION",
"city": "Cassopolis",
"state": "MI",
"postal_code": "490311034",
"country_code": "US",
"telephone_number": "269-228-8505",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERSON",
"first_name": "ELLIOT",
"middle_name": "RICHARD",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-14",
"last_updated": "2022-03-09",
"certification_date": "2022-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26025937A",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302039877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niles, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.