Active NPI
Family Fare, LLC
Doing business as Family Fare Pharmacy 254
- Pharmacy
- Grand Rapids, MI
National Provider Identifier
1114027448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 5301006943
- Legal business name
- FAMILY FARE, LLC
- Doing business as
- Family Fare Pharmacy 254
- Practice address
- 1225 Leonard St NE
Grand Rapids, MI 49505-5510 - Phone
- (616) 459-6203
- Fax
- (616) 454-8777
- NPI assigned
- Sep 25, 2006
- Last updated
- Dec 7, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amy Ellis, RPH
- Title
- Director of Pharmacy
- Phone
- (616) 878-2848
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 5301006943 | MI | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
1225 Leonard St NE
Grand Rapids, MI 49505-5510
Mailing address
1527 Momentum PL
Spartan Pharmacy North
Chicago, IL 60689-5315
Phone (616) 878-8584
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114027448 | Other | MI | NPI |
| 2353340 | Other | MI | NCPDP |
| 4075485 | Other | MI | MI-DME |
Other names 1
- FAMILY FARE PHARMACY 254
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2084477 | Family Fare Pharmacy #254 | Certificate of waiver | Sep 23, 2026 |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Grand Rapids, MI
- NPI 1659710895
-
- Pharmacist
- Grand Rapids, MI
- NPI 1053809111
-
- Pharmacist
- Grand Rapids, MI
- NPI 1033068051
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701907200000",
"number": "1114027448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1527 MOMENTUM PL",
"address_2": "SPARTAN PHARMACY NORTH",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606895315",
"telephone_number": "616-878-8584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 LEONARD ST NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495055510",
"telephone_number": "616-459-6203",
"fax_number": "616-454-8777"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FAMILY FARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-25",
"last_updated": "2023-12-07",
"certification_date": "2023-12-07",
"status": "A",
"authorized_official_last_name": "ELLIS",
"authorized_official_first_name": "AMY",
"authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
"authorized_official_telephone_number": "616-878-2848",
"authorized_official_credential": "RPH"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "MI",
"license": "5301006943",
"primary": true
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1114027448",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "2353340",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MI-DME",
"identifier": "4075485",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FAMILY FARE PHARMACY 254",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "FAMILY FARE PHARMACY 254",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Grand Rapids, MI
- Family & Pediatric Eye Care PLC
- Family Chiropractic Health Center
- Family Chiropractic Healthcare Center, PLLC
- Family Ear Nose Throat & Allergy
- Family Fare LLC (Family Fare - Forest Hills Pharmacy)
- Family Fare, LLC (D&W Pharmacy #1591)
- Family Fare, LLC (Family Fare Pharmacy 339)
- Family Fare, LLC (Family Fare Pharmacy 636)
- Family Fare, LLC (Family Fare Pharmacy 1587)
- Family Harmony LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.