Phil Joseph Demeulenaere III, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302030476 Issued in MI

Practice address

1710 W John Beers Rd
Stevensville, MI 49127-9409

Phone

(269) 429-1153

Fax

(269) 429-1495

NPI assigned

Sep 15, 2011

Last updated

Mar 4, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

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.

• Walgreen Co

  dba Walgreens #11265

  • Pharmacy
  • Stevensville, MI
  • NPI 1700073913
  NPD (past)
• Walgreen Co

  dba Walgreens #21605

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1235411133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3391 CEDAR LN",
            "city": "BRIDGMAN",
            "state": "MI",
            "postal_code": "491069739",
            "telephone_number": "269-465-9203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 W JOHN BEERS RD",
            "city": "STEVENSVILLE",
            "state": "MI",
            "postal_code": "491279409",
            "telephone_number": "269-429-1153",
            "fax_number": "269-429-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMEULENAERE",
        "first_name": "PHIL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-15",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IN",
            "license": "26019560A",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302030476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Rene Collins, LMT
• Barton L Comstock, MD
• Confident Care LLC (Serene Ridge Adult Foster Care Home)
• Kimberly May Cooper, O.D.
• Janelle M Cornforth, NP
• Dawn R Diggs, LPC
• Elizabeth RL Douce, MD
• Dr Melanie J Jones Optometrist PC
• Dr. William K. Wooten, D.C. P.C.
• Anne Dudley, D.O.

• Pharmacist in Stevensville, MI
• Providers in Stevensville, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.