Beaverton Family Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BEAVERTON FAMILY PHARMACY LLC

Doing business as

Beaverton Family Pharmacy

Practice address

3210 W Lang Rd
Beaverton, MI 48612-8102

Phone

(989) 339-9008

Fax

(855) 855-4919

NPI assigned

Aug 5, 2024

Last updated

Aug 5, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Gross, RPHNPI 1215457817

Title

Owner

Phone

(989) 339-9008

Specialties & licenses 1

Addresses

Other names 1

• BEAVERTON FAMILY PHARMACY Doing business as

Tax ID family

Beaverton Family Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Beaverton Family Pharmacy LLC

  dba Beaverton Family Pharmacy LTC

  • Long Term Care Pharmacy
  • Beaverton, MI
  • NPI 1053133975
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John W Gross, RPH

  • Pharmacist
  • Clare, MI
  • NPI 1215457817
  Authorized official Same address or phone

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

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722816000000",
    "number": "1194555201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11271 HARRISON AVE",
            "city": "FARWELL",
            "state": "MI",
            "postal_code": "486229439",
            "telephone_number": "989-339-9008",
            "fax_number": "855-855-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 W LANG RD",
            "city": "BEAVERTON",
            "state": "MI",
            "postal_code": "486128102",
            "telephone_number": "989-339-9008",
            "fax_number": "855-855-4919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVERTON FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-03",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-339-9008",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BEAVERTON FAMILY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Molly Patricia Allen, PHARMD
• At a Cross Road Counseling, PLLC
• Hannah Lee Baker
• Vinosha Balakrishnan, M.D
• Beaverton Family Pharmacy LLC (Beaverton Family Pharmacy LTC)
• Beaverton Medical Center P.C.
• Cheryl Ann Biddinger, MS, LPC
• Douglas W Bouchey, RPH
• Richard A Call, PA-C
• Amanda Lynn Cisse, MSW

• Community/Retail Pharmacy in Beaverton, MI
• Providers in Beaverton, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.