NPIMap

Organization Active NPI

Kentwood Pharmacy LLC

  • Pharmacy
  • Grand Rapids, MI
National Provider Identifier
1225352909
Registry record updated Mar 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
5301009297 Issued in MI
Legal business name
KENTWOOD PHARMACY LLC
Practice address
2026 Boston St. SE
Grand Rapids, MI 49506
Phone
(616) 452-9734
Fax
(616) 452-7255
NPI assigned
Mar 24, 2010
Last updated
Mar 24, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
KENTWOOD PHARMACY LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 24, 2010

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

Authorized official

Name
Mr. Kim Mulder
Title
Ceo
Phone
(616) 827-9100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 5301009297 MI Primary

Addresses

Primary practice location

2026 Boston St. SE
Grand Rapids, MI 49506

Mailing address

2480 44TH St SE
Grand Rapids, MI 49512
Phone (616) 827-9100

National Provider Directory

National Provider Directory
Tax ID family
Kentwood Pharmacy3 organizations share this tax ID, including this one
Part of
Kentwood Pharmacy

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1269388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269388800000",
    "number": "1225352909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 44TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49512",
            "telephone_number": "616-827-9100",
            "fax_number": "616-827-9116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2026 BOSTON ST. SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49506",
            "telephone_number": "616-452-9734",
            "fax_number": "616-452-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTWOOD PHARMACY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENTWOOD PHARMACY LLC",
        "enumeration_date": "2010-03-24",
        "last_updated": "2010-03-24",
        "status": "A",
        "authorized_official_last_name": "MULDER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-827-9100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301009297",
            "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 Mar 24, 2010; 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.