Central Pharmacy-Mattawan LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301009144 Issued in MI

Legal business name

CENTRAL PHARMACY-MATTAWAN LLC

Doing business as

Medicine Tree Pharmacy

Practice address

56109 Village Center Cir
Mattawan, MI 49071-8368

Phone

(269) 668-6801

Fax

(269) 668-6802

NPI assigned

Jul 16, 2009

Last updated

Mar 28, 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

Mohamed A BeydounNPI 1417510462

Title

Owner

Phone

(269) 673-4700

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Medicine Tree Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Tax ID family

Central Pharmacy-Mattawan LLC2 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.

• Central Pharmacy-Mattawan LLC

  dba Medicine Tree Pharmacy

  • Long Term Care Pharmacy
  • Mattawan, MI
  • NPI 1811468614
  NPD tax ID

Locations

Practitioners 5

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.

• Mohamed A Beydoun, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Allegan, MI
  • NPI 1417510462
  Authorized official Same address or phone
• Juliann Bradish

  • Pharmacist
  • Plainwell, MI
  • NPI 1386224335
  NPD (past)
• Donald C Jacks, R.PH.

  • Pharmacist
  • Mattawan, MI
  • NPI 1235122037
  NPD (past)
• Timothy James Sassin, PHARM.D

  • Pharmacist
  • Mattawan, MI
  • NPI 1528521036
  NPD (past)
• Andrew John Tironi, PHARMD

  • Pharmacist
  • Mattawan, MI
  • NPI 1710669692
  NPD (past)

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679961600000",
    "number": "1356571988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56109 VILLAGE CENTER CIR",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490718368",
            "telephone_number": "269-668-6801",
            "fax_number": "269-668-6802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56109 VILLAGE CENTER CIR",
            "city": "MATTAWAN",
            "state": "MI",
            "postal_code": "490718368",
            "telephone_number": "269-668-6801",
            "fax_number": "269-668-6802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL PHARMACY-MATTAWAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-16",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "BEYDOUN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-673-4700"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301009144",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2372972",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2121009",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medicine Tree Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Medicine Tree Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bronson Nursing and Rehabilitation Center (Bronson Commons)
• Bronson Village Drug, Inc. (Aurora Long Term Care)
• Christine V Call, REGISTERED NURSE
• Rebecca Carr, M.S. CCC-SLP
• Bailey Rose Caton, LAT, ATC
• Central Pharmacy-Mattawan LLC (Medicine Tree Pharmacy)
• Angeli Certa, PHARM.D.
• Marjean Elisabeth Chacon
• Karen Elizabeth Chandler, NP
• Gabriella M Cox

• Community/Retail Pharmacy in Mattawan, MI
• Providers in Mattawan, 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 Mar 28, 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.