Active NPI
Ashley Koubaitary
- Pharmacist
- Benton Harbor, MI
National Provider Identifier
1235696014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302042708
- Practice address
- 1920 Pipestone Rd
Benton Harbor, MI 49022-2315 - Phone
- (269) 934-6710
- NPI assigned
- Feb 27, 2019
- 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 | 5302042708 | MI | Primary |
Addresses
Primary practice location
1920 Pipestone Rd
Benton Harbor, MI 49022-2315
Mailing address
58380 County Road 365 N
Lawrence, MI 49064-9747
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 |
|---|---|---|---|
| 5302042708 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meijer Inc | Past | Accepting new patients | |
| Meijer Inc | 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.
-
- Community/Retail Pharmacy
- Macomb, MI
- NPI 1033833538
-
- Community/Retail Pharmacy
- Benton Harbor, MI
- NPI 1811037351
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551225600000",
"number": "1235696014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58380 COUNTY ROAD 365 N",
"city": "LAWRENCE",
"state": "MI",
"postal_code": "490649747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 PIPESTONE RD",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490222315",
"telephone_number": "269-934-6710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOUBAITARY",
"first_name": "ASHLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-27",
"last_updated": "2019-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302042708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.