NPIMap

Organization Active NPI

Medicine Mart Inc.

  • Community/Retail Pharmacy
  • Kalamazoo, MI
National Provider Identifier
1013012236
Registry record updated May 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301007505 Issued in MI
Legal business name
MEDICINE MART INC.
Practice address
5585 Gull Rd
Suite 120
Kalamazoo, MI 49048-6703
Phone
(269) 553-5000
Fax
(269) 553-0555
NPI assigned
Sep 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2017

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

Authorized official

Name
Michael M DabajaNPI 1043561723
Title
Vice President
Phone
(269) 553-5000

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301007505 MI Primary

Addresses

Primary practice location

5585 Gull Rd
Suite 120
Kalamazoo, MI 49048-6703

Mailing address

5585 Gull Rd
Suite 120
Kalamazoo, MI 49048-6703
Phone (269) 553-5000

Other identifiers 1

IdentifierTypeStateIssuer
4369377MedicaidMI

Other names 1

  • Gull Pointe Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100305000788 MI Part B Supplier - Mass Immunization (Roster Biller Only) 7911042643 Practice locations: Kalamazoo, MI

National Provider Directory

National Provider Directory

Locations

5585 Gull Rd
Ste 120
Kalamazoo, MI 49048
Phone (269) 553-5000

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494374400000",
    "number": "1013012236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5585 GULL RD",
            "address_2": "SUITE 120",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490486703",
            "telephone_number": "269-553-5000",
            "fax_number": "269-553-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5585 GULL RD",
            "address_2": "SUITE 120",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490486703",
            "telephone_number": "269-553-5000",
            "fax_number": "269-553-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICINE MART INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2017-05-10",
        "status": "A",
        "authorized_official_last_name": "DABAJA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "269-553-5000"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301007505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4369377",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gull Pointe Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2017; 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.