BROAD STREET PHARMACY, INC — NPI 1952864951 (Licensed & Credentialed Suppliers — Pharmacy, Long-term Care Pharmacy in CHESANING, MI)

CMS-1500 Box 24J / 33a • NPI

1952864951

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3336L0003X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy, Long-term Care Pharmacy

Box 32 Service Location & ZIP+4

1115 W BROAD ST, CHESANING, MI, 48616-1068

✓ 9-Digit EDI 837 ZIP+4 (48616-1068)

Practice Phone & Referral Fax

(989) 845-9355

Fax: (989) 845-9356

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1952864951 (BROAD STREET PHARMACY, INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1952864951` (NPI-2 Organization / Facility)
Provider / Legal Name	BROAD STREET PHARMACY, INC
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy, Long-term Care Pharmacy NUCC Code: `3336L0003X` (Pharmacy, Long Term Care Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1115 W BROAD ST, CHESANING, MI, 48616-1068
Practice Telephone / Fax	Tel: (989) 845-9355 \| Fax: (989) 845-9356
Administrative Mailing Address	1115 W BROAD ST, CHESANING, MI, 48616-1068
Enumeration & Last Sync	Enumerated: 2019-04-08 \| CMS Record Updated: 2025-11-06
Authorized Official	TAMARA MASON (owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1115 W BROAD ST, CHESANING, MI, 48616-1068

🗺️ Open in Google Maps 🏥 More Providers in CHESANING

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Plain-English Taxonomy & CMS Crosswalk (3336L0003X)

What Does Taxonomy Code 3336L0003X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3336L0003X translates to:
"Licensed & Credentialed Suppliers — Pharmacy, Long-term Care Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy, Long Term Care Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BROAD STREET PHARMACY, INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3336C0003X` — Pharmacy, Community/Retail Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy	State: N/A \| License: `Verified` \| Primary: Secondary
`3336L0003X` — Pharmacy, Long Term Care Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Long-term Care Pharmacy	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BROAD STREET PHARMACY, INC (NPI #1952864951)