Active NPI
Heather Pentecost
- Pharmacist
- Jenison, MI
National Provider Identifier
1265716054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302039196
- Practice address
- 1965 Baldwin St
Jenison, MI 49428-8915 - Phone
- (616) 457-9630
- NPI assigned
- Sep 28, 2011
- Last updated
- Sep 28, 2011
- 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 | 5302039196 | MI | Primary |
| Pharmacist | 183500000X | 18087 | CO |
Addresses
Primary practice location
1965 Baldwin St
Jenison, MI 49428-8915
Mailing address
1965 Baldwin St
Jenison, MI 49428-8915
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 |
|---|---|---|---|
| 18087 | CO | MD | Pharmacist |
| 5302039196 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Fare, LLC | Past | Accepting new patients | |
| Family Fare, LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1265716054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1965 BALDWIN ST",
"city": "JENISON",
"state": "MI",
"postal_code": "494288915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1965 BALDWIN ST",
"city": "JENISON",
"state": "MI",
"postal_code": "494288915",
"telephone_number": "616-457-9630"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENTECOST",
"first_name": "HEATHER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-28",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302039196",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CO",
"license": "18087",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jenison, MI
- Pacific Counseling Services PLLC
- Alec James Papes, DC
- Patchwork Therapy Services
- Patient One Care PLLC (AFC Urgent Care)
- Elizabeth Payne
- David Charles Perrin, MS PT, ATC, CSCS
- Perspectives of Troy, PC (Jenison Psychological Services PC)
- Hannah Pettinga, M.A. CCC-SLP
- Clara Phillips
- Brynne Alysse Pieters, OTRL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.