Active NPI
Jacob Crockett
- Pharmacy Technician
- Howell, MI
National Provider Identifier
1285495812
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 5303001165
- Practice address
- 3850 E Grand River Ave
Howell, MI 48843-8593 - Phone
- (517) 548-9511
- NPI assigned
- Jan 22, 2024
- Last updated
- Jan 22, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 5303001165 | MI | Primary |
Addresses
Primary practice location
3850 E Grand River Ave
Howell, MI 48843-8593
Mailing address
4216 Lancashire
Milford, MI 48380-1125
Phone (248) 807-8699
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 |
|---|---|---|---|
| 5303001165 | MI | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1285495812",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4216 LANCASHIRE",
"city": "MILFORD",
"state": "MI",
"postal_code": "483801125",
"telephone_number": "248-807-8699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3850 E GRAND RIVER AVE",
"city": "HOWELL",
"state": "MI",
"postal_code": "488438593",
"telephone_number": "517-548-9511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKETT",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-22",
"last_updated": "2024-01-22",
"certification_date": "2024-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "MI",
"license": "5303001165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Howell, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.