Organization Active NPI

Broad Street Pharmacy, Inc

  • Long Term Care Pharmacy
  • Chesaning, MI
National Provider Identifier
1952864951
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
BROAD STREET PHARMACY, INC
Practice address
1115 W Broad St
Chesaning, MI 48616-1068
Phone
(989) 845-9355
Fax
(989) 845-9356
NPI assigned
Apr 8, 2019
Last updated
Nov 6, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BROAD STREET PHARMACY, LTCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

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

Authorized official

Name
Dr. Tamara Elizabeth MasonNPI 1346322849
Title
Owner
Phone
(989) 845-9355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

1115 W Broad St
Chesaning, MI 48616-1068

Mailing address

1115 W Broad St
Chesaning, MI 48616-1068
Phone (989) 845-9355

Other names 1

  • BROAD STREET PHARMACY, LTC Other name

National Provider Directory

National Provider Directory
Part of
Broad Street Pharmacy Inc

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762387200000",
    "number": "1952864951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 W BROAD ST",
            "city": "CHESANING",
            "state": "MI",
            "postal_code": "486161068",
            "telephone_number": "989-845-9355",
            "fax_number": "989-845-9356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 W BROAD ST",
            "city": "CHESANING",
            "state": "MI",
            "postal_code": "486161068",
            "telephone_number": "989-845-9355",
            "fax_number": "989-845-9356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD STREET PHARMACY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROAD STREET PHARMACY, LTC",
        "enumeration_date": "2019-04-08",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-845-9355",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROAD STREET PHARMACY, LTC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chesaning, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; 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.