Active NPI
Kyle Marenger
- Pharmacist
- Escanaba, MI
National Provider Identifier
1215539598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302040719
- Practice address
- 601 N Lincoln Rd
Escanaba, MI 49829-1426 - Phone
- (906) 786-1232
- NPI assigned
- Nov 12, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 5302040719 | MI | Primary |
Addresses
Primary practice location
601 N Lincoln Rd
Escanaba, MI 49829-1426
Mailing address
5545 25TH Rd
Gladstone, MI 49837-8820
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302040719 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605139200000",
"number": "1215539598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5545 25TH RD",
"city": "GLADSTONE",
"state": "MI",
"postal_code": "498378820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 N LINCOLN RD",
"city": "ESCANABA",
"state": "MI",
"postal_code": "498291426",
"telephone_number": "906-786-1232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARENGER",
"first_name": "KYLE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-12",
"last_updated": "2020-11-12",
"certification_date": "2020-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pharmacist",
"state": "MI",
"license": "5302040719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Escanaba, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.