NPIMap

Individual provider Active NPI

Owen T. Weidig, RPH

  • Pharmacist
  • Port Huron, MI
National Provider Identifier
1164708699
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302410763 Issued in MI
Practice address
1215 24TH St
Port Huron, MI 48060-4812
Phone
(810) 987-7155
Fax
(810) 987-4017
NPI assigned
Oct 28, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302410763 MI Primary

Addresses

Primary practice location

1215 24TH St
Port Huron, MI 48060-4812

Mailing address

1617 10TH St
Port Huron, MI 48060-5844
Phone (810) 987-5083

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
5302410763MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kroger Co of Michigan PastSince Jan 26, 2020 Accepting new patients
Kroger Co of Michigan PastSince Jan 26, 2020 Accepting new patients
Walgreen Co PastSince Sep 15, 2024 Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1319760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1164708699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 10TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605844",
            "telephone_number": "810-987-5083",
            "fax_number": "810-987-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 24TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480604812",
            "telephone_number": "810-987-7155",
            "fax_number": "810-987-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEIDIG",
        "first_name": "OWEN",
        "middle_name": "T.",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-28",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302410763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.

Verify at the official NPI Registry.