Pharmasource LTC LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

PHARMASOURCE LTC LLC

Practice address

31620 Grand River Ave
Farmington, MI 48336-4234

Phone

(313) 680-3000

NPI assigned

Nov 15, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Fadi NaserdeanNPI 1841392743

Title

Principal

Phone

(734) 261-4100

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Fadi Mohamad Naserdean, RPH

  • Pharmacist
  • Dearborn, MI
  • NPI 1841392743
  NPD Authorized official
• Heba Phayes Carcora, PHARMD

  • Pharmacist
  • Farmington, MI
  • NPI 1962359000
  NPD (past)

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1043789431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31620 GRAND RIVER AVE",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483364234",
            "telephone_number": "734-261-4100",
            "fax_number": "734-261-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31620 GRAND RIVER AVE",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483364234",
            "telephone_number": "313-680-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMASOURCE LTC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "NASERDEAN",
        "authorized_official_first_name": "FADI",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "734-261-4100",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shruti Mahendrakumar Patel, PHARM.D
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• Christopher Richard Perkins, D.C.
• Katrina Renee Peters
• Prodigal Journey, LLC
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• Professional Services of Sherry Mullins, LLC
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• Elizabeth Ann Putt

• Long Term Care Pharmacy in Farmington, MI
• Providers in Farmington, MI by specialty
• Long Term Care Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.