Longacres Ana Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009552 Issued in MI

Legal business name

LONGACRES ANA INC

Doing business as

Medina Pharmacy

Practice address

8744 W Warren Ave
Dearborn, MI 48126-4043

Phone

(313) 397-6919

Fax

(313) 397-9258

NPI assigned

Apr 3, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Nasr MansourNPI 1699924746

Title

President

Phone

(313) 397-6919

Specialties & licenses 2

Addresses

Other names 1

• Medina Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

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

Medicare medical equipment & supply locations

Tax ID family

Perrys Save on 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.

• Perrys Save on Pharmacy

  • Pharmacy
  • Pontiac, MI
  • NPI 1164669933
  NPD tax ID

Practitioners 1

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

• Nasr Mansour

  • Pharmacist
  • Dearborn, MI
  • NPI 1699924746
  NPD Authorized official

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

{
    "created_epoch": "1301788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482969600000",
    "number": "1265721955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8744 W WARREN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264043",
            "telephone_number": "313-396-7691",
            "fax_number": "313-397-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8744 W WARREN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264043",
            "telephone_number": "313-397-6919",
            "fax_number": "313-397-9258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGACRES ANA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-03",
        "last_updated": "2016-12-29",
        "status": "A",
        "authorized_official_last_name": "MANSOUR",
        "authorized_official_first_name": "NASR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-397-6919",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medina Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Logan, RN, NP
• Chloe Joy Lohmeyer
• Mistie Lohrengel
• Brenda Chanthou Long
• Brian Michael Long, D.D.S.
• Stacey Lonser
• Richard Loosvelt, MA, LPC
• Frederick Louis Lopatin, D.O.
• Angelina Marie Lopez
• Thomas Michael Lopez

• Community/Retail Pharmacy in Dearborn, MI
• Providers in Dearborn, 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 Dec 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.