NPIMap

Organization Active NPI

Walnut Associates I LLC

  • Community/Retail Pharmacy
  • Trenton, MI
National Provider Identifier
1003924465
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301006407 Issued in MI
Legal business name
WALNUT ASSOCIATES I LLC
Practice address
3390 West Road
Trenton, MI 48183
Phone
(734) 676-6622
Fax
(734) 676-5725
NPI assigned
Aug 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Newman
Title
Ceo
Phone
(248) 354-0282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301006407 MI Primary

Addresses

Primary practice location

3390 West Road
Trenton, MI 48183

Mailing address

3390 West Road
Trenton, MI 48183-2323
Phone (734) 676-6622

Other identifiers 2

IdentifierTypeStateIssuer
2308054MedicaidMI
2308054OtherOTHER ID NUMBER

Other names 1

  • WEST GRANGE PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930055428 MI DME Supplier - Pharmacy 3375662174 Practice locations: Trenton, MI
O20190822000135 MI Part B Supplier - Mass Immunization (Roster Biller Only) 3375662174 Practice locations: Trenton, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526601600000",
    "number": "1003924465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3390 WEST ROAD",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481832323",
            "telephone_number": "734-676-6622",
            "fax_number": "734-676-5725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3390 WEST ROAD",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "48183",
            "telephone_number": "734-676-6622",
            "fax_number": "734-676-5725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALNUT ASSOCIATES I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2018-05-18",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-354-0282",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301006407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2308054",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2308054",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WEST GRANGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.