Active NPI
Jennifer Marie Dudek, PHARMD
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1225314446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302029305
- Practice address
- 5241 Northland Dr NE
Grand Rapids, MI 49525-1041 - Phone
- (616) 447-2788
- NPI assigned
- Nov 2, 2011
- Sex
- Female
- 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 | 5302029305 | MI | Primary |
Addresses
Primary practice location
5241 Northland Dr NE
Grand Rapids, MI 49525-1041
Mailing address
3669 Windshire Dr SE
Grand Rapids, MI 49546-3684
Phone (616) 575-6454
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 |
|---|---|---|---|
| 5302029305 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Fare, LLC | Past | Accepting new patients | |
| Family Fare, LLC | Past | Accepting new patients |
Organizations & group practices 2
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": "1320192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320192000000",
"number": "1225314446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3669 WINDSHIRE DR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495463684",
"telephone_number": "616-575-6454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5241 NORTHLAND DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495251041",
"telephone_number": "616-447-2788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDEK",
"first_name": "JENNIFER",
"middle_name": "MARIE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-02",
"last_updated": "2011-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302029305",
"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 Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.