Active NPI
Jerika Nguyen, PHARMD, BCPS, BCCCP
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1164031860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302411567
- Practice address
- 525 Clancy Ave NE Apt 120
Grand Rapids, MI 49503-1843 - Phone
- (616) 350-1555
- NPI assigned
- Jul 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH-0016027 | OR | |
| Pharmacist | 183500000X | RP452948 | PA | |
| Critical Care Pharmacist | 1835C0205X | 7152564 | MI | |
| Pharmacotherapy Pharmacist | 1835P1200X | 3158708 | MI | |
| Pharmacist | 183500000X | 5302411567 | MI | Primary |
Addresses
Primary practice location
525 Clancy Ave NE Apt 120
Grand Rapids, MI 49503-1843
Mailing address
525 Clancy Ave NE Apt 120
Grand Rapids, MI 49503-1843
Phone (616) 350-1555
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302411567 | MI | MD | Pharmacist |
| RPH-0016027 | OR | MD | Pharmacist |
| RP452948 | PA | MD | Pharmacist |
| 7152564 | MI | MD | Critical Care Pharmacist |
| 3158708 | MI | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595894400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595894400000",
"number": "1164031860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 CLANCY AVE NE APT 120",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495031843",
"telephone_number": "616-350-1555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 CLANCY AVE NE APT 120",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495031843",
"telephone_number": "616-350-1555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "JERIKA",
"name_prefix": "Dr.",
"credential": "PHARMD, BCPS, BCCCP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-28",
"last_updated": "2020-07-28",
"certification_date": "2020-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OR",
"license": "RPH-0016027",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "PA",
"license": "RP452948",
"primary": false
},
{
"code": "1835C0205X",
"taxonomy_group": "",
"desc": "Pharmacist, Critical Care",
"state": "MI",
"license": "7152564",
"primary": false
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "MI",
"license": "3158708",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302411567",
"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 Jul 28, 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.