Active NPI
Kent Frances Dickerson, RPH
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1104146596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302031457
- Practice address
- 2036 Lake Michigan Dr NW
Grand Rapids, MI 49504-4743 - Phone
- (616) 453-8750
- Fax
- (616) 453-0107
- NPI assigned
- Jun 8, 2010
- 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 | 5302031457 | MI | Primary |
Addresses
Primary practice location
2036 Lake Michigan Dr NW
Grand Rapids, MI 49504-4743
Mailing address
2036 Lake Michigan Dr NW
Grand Rapids, MI 49504-4743
Phone (616) 453-8750
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 |
|---|---|---|---|
| 5302031457 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275955200000",
"number": "1104146596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2036 LAKE MICHIGAN DR NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495044743",
"telephone_number": "616-453-8750",
"fax_number": "616-453-0107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2036 LAKE MICHIGAN DR NW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495044743",
"telephone_number": "616-453-8750",
"fax_number": "616-453-0107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "KENT",
"middle_name": "FRANCES",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-08",
"last_updated": "2010-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302031457",
"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 Jun 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.