Active NPI
Allegan Pharmacy LLC
- Community/Retail Pharmacy
- Allegan, MI
National Provider Identifier
1871641878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5301008560
- Legal business name
- ALLEGAN PHARMACY LLC
- Doing business as
- ALLEGAN MEDICAL CENTER PHARMACY
- Practice address
- 551 Linn St
Ste120
Allegan, MI 49010 - Phone
- (269) 673-4700
- Fax
- (269) 673-4711
- NPI assigned
- Jan 8, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Mohamed Ali Beydoun, PHARM D
- Title
- Owner
- Phone
- (313) 378-1938
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 5301008560 | MI | Primary |
Addresses
Primary practice location
551 Linn St
Ste120
Allegan, MI 49010
Mailing address
551 Linn St
Ste120
Allegan, MI 49010
Phone (269) 673-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2042556 | Other | PK |
Other names 1
- ALLEGAN MEDICAL CENTER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231011001158 | MI | Part B Supplier - Pharmacy | 9436560703 | Practice locations: Allegan, MI |
National Provider Directory
National Provider Directory- Tax ID family
- Allegan Medical Center Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pharmacy
- Allegan, MI
- NPI 1134279870
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1697932800000",
"number": "1871641878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "551 LINN ST",
"address_2": "STE120",
"city": "ALLEGAN",
"state": "MI",
"postal_code": "49010",
"telephone_number": "269-673-4700",
"fax_number": "269-673-4711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "551 LINN ST",
"address_2": "STE120",
"city": "ALLEGAN",
"state": "MI",
"postal_code": "49010",
"telephone_number": "269-673-4700",
"fax_number": "269-673-4711"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ALLEGAN PHARMACY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-08",
"last_updated": "2023-10-22",
"certification_date": "2023-10-22",
"status": "A",
"authorized_official_last_name": "BEYDOUN",
"authorized_official_first_name": "MOHAMED",
"authorized_official_middle_name": "ALI",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "313-378-1938",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "PHARM D"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5301008560",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2042556",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "ALLEGAN MEDICAL CENTER PHARMACY",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "ALLEGAN MEDICAL CENTER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Allegan, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.