Active NPI
Mark Gustafson, PHARM.D.
- Pharmacist
- Holland, MI
National Provider Identifier
1346633492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302039944
- Practice address
- 494 Butternut Dr
Holland, MI 49424-1556 - Phone
- (616) 786-2235
- NPI assigned
- Mar 13, 2015
- Last updated
- Mar 13, 2015
- 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 | 5302039944 | MI | Primary |
Addresses
Primary practice location
494 Butternut Dr
Holland, MI 49424-1556
Mailing address
494 Butternut Dr
Holland, MI 49424-1556
Phone (616) 786-2235
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 |
|---|---|---|---|
| 5302039944 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
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": "1426204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1426204800000",
"number": "1346633492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "494 BUTTERNUT DR",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494241556",
"telephone_number": "616-786-2235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "494 BUTTERNUT DR",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494241556",
"telephone_number": "616-786-2235"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUSTAFSON",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-03-13",
"last_updated": "2015-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302039944",
"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 Mar 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.