Active NPI
Matthew Russell Hines
- Pharmacist
- Howell, MI
National Provider Identifier
1053916288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302034263
- Practice address
- 2400 W Grand River Ave
Howell, MI 48843-8585 - Phone
- (517) 548-7070
- NPI assigned
- Dec 4, 2020
- Sex
- Male
- 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 | 5302034263 | MI | Primary |
Addresses
Primary practice location
2400 W Grand River Ave
Howell, MI 48843-8585
Mailing address
1550 Gezon Pkwy SW Ste E-101
Wyoming, MI 49509-9397
Phone (517) 712-5376
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302034263 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607040000000",
"number": "1053916288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1550 GEZON PKWY SW STE E-101",
"city": "WYOMING",
"state": "MI",
"postal_code": "495099397",
"telephone_number": "517-712-5376"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 W GRAND RIVER AVE",
"city": "HOWELL",
"state": "MI",
"postal_code": "488438585",
"telephone_number": "517-548-7070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HINES",
"first_name": "MATTHEW",
"middle_name": "RUSSELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-04",
"last_updated": "2020-12-04",
"certification_date": "2020-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302034263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Howell, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.