Fowlerville RX LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301004232 Issued in MI

Legal business name

FOWLERVILLE RX LLC

Doing business as

Fowlerville Pharmacy

Practice address

119 E Grand River Ave
Fowlerville, MI 48836

Phone

(517) 223-9832

Fax

(517) 223-7267

NPI assigned

Aug 7, 2006

Last updated

Nov 14, 2023By 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

Krishna Kandagatla

Title

Member

Phone

(517) 316-6716

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• FOWLERVILLE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Tax ID family

Fowlerville 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.

• Fowlerville RX LLC

  dba Fowlerville Pharmacy

  • Long Term Care Pharmacy
  • Fowlerville, MI
  • NPI 1932968740
  NPD tax ID

Locations

Practitioners 2

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.

• Michael Paul Heidt, PHARMD

  • Pharmacist
  • Fowlerville, MI
  • NPI 1982228003
  NPD
• David R Palan, RPH

  • Pharmacist
  • Fowlerville, MI
  • NPI 1689751406

  Community/Retail Pharmacy

  NPD (past)

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1326057308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 E GRAND RIVER AVE",
            "city": "FOWLERVILLE",
            "state": "MI",
            "postal_code": "48836",
            "telephone_number": "517-223-9832",
            "fax_number": "517-223-7267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 E GRAND RIVER AVE",
            "city": "FOWLERVILLE",
            "state": "MI",
            "postal_code": "48836",
            "telephone_number": "517-223-9832",
            "fax_number": "517-223-7267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOWLERVILLE RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "KANDAGATLA",
        "authorized_official_first_name": "KRISHNA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "517-316-6716"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301004232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2339100",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOWLERVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FOWLERVILLE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nelson Grey Edwards, O.D.
• Fowlerville Chiropractic Center
• Fowlerville Counseling Center
• Fowlerville Family Dentistry
• Fowlerville Medical Center, PLC
• Fowlerville RX LLC (Fowlerville Pharmacy)
• Samantha Rose Franceschina
• Marie Elizabeth Gannon, O.D.
• Heather Diane Gilroy, RN, FNP-C
• Tom Lavern Hall II, OD

• Community/Retail Pharmacy in Fowlerville, MI
• Providers in Fowlerville, 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 Nov 14, 2023; 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.