Active NPI
Tiffany Elaine Carlson
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1245747518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302411724
- Practice address
- 3757 Plainfield Ave NE
Grand Rapids, MI 49525-2403 - Phone
- (616) 364-6211
- NPI assigned
- Jan 8, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 81910 | CA | |
| Pharmacist | 183500000X | 5302411724 | MI | Primary |
Addresses
Primary practice location
3757 Plainfield Ave NE
Grand Rapids, MI 49525-2403
Mailing address
3474 Stephanie Dr
Hudsonville, MI 49426-7535
Other practice location 1
25 Michigan St NE
Grand Rapids, MI 49503-2515
Phone (616) 643-1138
Other names 1
- Tiffany Elaine Agate
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tiffany.agate@meijer.com | Direct |
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 |
|---|---|---|---|
| 81910 | CA | MD | Marriage & Family Therapist |
| 5302411724 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629936000000",
"number": "1245747518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3474 STEPHANIE DR",
"city": "HUDSONVILLE",
"state": "MI",
"postal_code": "494267535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3757 PLAINFIELD AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495252403",
"telephone_number": "616-364-6211"
}
],
"practiceLocations": [
{
"address_1": "25 Michigan St NE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495032515",
"country_code": "US",
"telephone_number": "616-643-1138",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARLSON",
"first_name": "TIFFANY",
"middle_name": "ELAINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-08",
"last_updated": "2021-08-26",
"certification_date": "2021-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "81910",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302411724",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tiffany.agate@meijer.com",
"affiliation": "N",
"endpointDescription": "work email",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "3757 Plainfield Ave NE",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495252403",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "TIFFANY",
"last_name": "AGATE",
"middle_name": "ELAINE",
"credential": "PHARMD",
"code": "1",
"type": "Former Name"
}
]
}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 Aug 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.