Active NPI
Kelli Deyoung, R.PH
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1043747801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302030161
- Practice address
- 100 Cherry St SE
Grand Rapids, MI 49503-4526 - Phone
- (616) 965-8278
- Fax
- (616) 940-5805
- NPI assigned
- May 11, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302030161 | MI | Primary |
Addresses
Primary practice location
100 Cherry St SE
Grand Rapids, MI 49503-4526
Mailing address
100 Cherry St SE
Grand Rapids, MI 49503-4526
Phone (616) 965-8278
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302030161 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494460800000",
"number": "1043747801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 CHERRY ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034526",
"telephone_number": "616-965-8278",
"fax_number": "616-940-5805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CHERRY ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034526",
"telephone_number": "616-965-8278",
"fax_number": "616-940-5805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEYOUNG",
"first_name": "KELLI",
"credential": "R.PH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-11",
"last_updated": "2017-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302030161",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.