Active NPI
Nicholas Scott Kreitzbender, PHARM.D.
- Pharmacist
- Port Huron, MI
National Provider Identifier
1215530936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302413109
- Practice address
- 940 Lapeer Ave
Port Huron, MI 48060-4414 - Phone
- (810) 982-4721
- Fax
- (810) 982-4783
- NPI assigned
- Nov 17, 2020
- Last updated
- Apr 16, 2021
- 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 | 5302413109 | MI | Primary |
Addresses
Primary practice location
940 Lapeer Ave
Port Huron, MI 48060-4414
Mailing address
940 Lapeer Ave
Port Huron, MI 48060-4414
Phone (810) 982-4721
Other practice location 1
4514 Gratiot Rd
Kimball, MI 48074-4508
Phone (810) 364-6980
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 |
|---|---|---|---|
| 5302413109 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618531200000",
"number": "1215530936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "940 LAPEER AVE",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480604414",
"telephone_number": "810-982-4721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 LAPEER AVE",
"city": "PORT HURON",
"state": "MI",
"postal_code": "480604414",
"telephone_number": "810-982-4721",
"fax_number": "810-982-4783"
}
],
"practiceLocations": [
{
"address_1": "4514 Gratiot Rd",
"address_purpose": "LOCATION",
"city": "Kimball",
"state": "MI",
"postal_code": "480744508",
"country_code": "US",
"telephone_number": "810-364-6980",
"fax_number": "810-364-1883",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KREITZBENDER",
"first_name": "NICHOLAS",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-17",
"last_updated": "2021-04-16",
"certification_date": "2021-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302413109",
"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 Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.