Individual provider Active NPI

David Joseph Miller, RPH, PHD

  • Pharmacist
  • Grand Rapids, MI
National Provider Identifier
1245712116
Registry record updated Sep 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302027363 Issued in MI
Practice address
4021 Cascade Rd SE
Suite 50
Grand Rapids, MI 49546
Phone
(616) 974-9792
Fax
(616) 464-3469
NPI assigned
Sep 6, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302027363 MI Primary

Addresses

Primary practice location

4021 Cascade Rd SE
Suite 50
Grand Rapids, MI 49546

Mailing address

Keystone Pharmacy
4021 Cascade Rd SE Suite 50
Grand Rapids, MI 49546
Phone (616) 974-9792

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 Philosophy, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
5302027363MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Keystone Pharmacy, Inc. CurrentSince Dec 28, 2022 Accepting new patients
Keystone Pharmacy Inc Current Accepting new patients

Locations

4021 Cascade Rd SE
Ste 50
Grand Rapids, MI 49546
Phone (616) 974-9792

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": "1536192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536192000000",
    "number": "1245712116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "KEYSTONE PHARMACY",
            "address_2": "4021 CASCADE RD SE SUITE 50",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-974-9792",
            "fax_number": "616-464-3469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4021 CASCADE RD SE",
            "address_2": "SUITE 50",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-974-9792",
            "fax_number": "616-464-3469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "DAVID",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "RPH, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-06",
        "last_updated": "2018-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302027363",
            "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 Sep 6, 2018; 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.