Active NPI
Rajendra D Bavada, R.PH
- Pharmacist
- Kentwood, MI
National Provider Identifier
1346524030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302028364
- Practice address
- 6127 Kalamazoo Ave SE
Kentwood, MI 49508-7019 - Phone
- (616) 696-6234
- NPI assigned
- Sep 29, 2011
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302028364 | MI | Primary |
Addresses
Primary practice location
6127 Kalamazoo Ave SE
Kentwood, MI 49508-7019
Mailing address
1340 Penncross Dr SE
Caledonia, MI 49316-9041
Phone (616) 554-9409
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302028364 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317254400000",
"number": "1346524030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1340 PENNCROSS DR SE",
"city": "CALEDONIA",
"state": "MI",
"postal_code": "493169041",
"telephone_number": "616-554-9409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6127 KALAMAZOO AVE SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495087019",
"telephone_number": "616-696-6234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAVADA",
"first_name": "RAJENDRA",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "R.PH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-29",
"last_updated": "2011-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302028364",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kentwood, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.