Individual provider Active NPI

Lisa Tyjewski, RPH.

  • Pharmacist
  • Muskegon, MI
National Provider Identifier
1053400770
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302031527 Issued in MI
Practice address
961 Spring St
Muskegon, MI 49442-3278
Phone
(231) 722-2861
Fax
(231) 726-5522
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302031527 MI Primary

Addresses

Primary practice location

961 Spring St
Muskegon, MI 49442-3278

Mailing address

3498 Whispering Woods Dr
Muskegon, MI 49444-5402
Phone (231) 777-3572

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

LicenseStateTypeSpecialty
5302031527MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Benson Drug Company Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053400770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3498 WHISPERING WOODS DR",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494445402",
            "telephone_number": "231-777-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "961 SPRING ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494423278",
            "telephone_number": "231-722-2861",
            "fax_number": "231-726-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYJEWSKI",
        "first_name": "LISA",
        "name_prefix": "Ms.",
        "credential": "RPH.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302031527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.