Active NPI
Kaitlyn Craddock, PHARMD
- Ambulatory Care Pharmacist
- Holland, MI
National Provider Identifier
1306322458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ambulatory Care Pharmacist
- License
- 5302046746
- Practice address
- 588 E Lakewood Blvd FL 2
Holland, MI 49424-2023 - Phone
- (616) 494-5800
- NPI assigned
- Jul 12, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Care Pharmacist | 1835P2201X | 5302046746 | MI | Primary |
Addresses
Primary practice location
588 E Lakewood Blvd FL 2
Holland, MI 49424-2023
Mailing address
665 Seward Ave NW Ste 320
Grand Rapids, MI 49504-5190
Phone (616) 267-7029
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 Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302046746 | MI | MD | Ambulatory Care Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531353600000",
"number": "1306322458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 SEWARD AVE NW STE 320",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495045190",
"telephone_number": "616-267-7029",
"fax_number": "616-391-9085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "588 E LAKEWOOD BLVD FL 2",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494242023",
"telephone_number": "616-494-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRADDOCK",
"first_name": "KAITLYN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-12",
"last_updated": "2018-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "MI",
"license": "5302046746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.