Vicky Lynne Klaassen, CPHT

Key facts

NPI

1366023988

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacy Technician 183700000X

License

5303002666 (MI)

Practice address

3999 Alpine Ave NW
Comstock Park, MI 49321-8350

Phone

(616) 784-1619

Fax

(616) 784-2454

NPI assigned

Apr 15, 2021

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 15, 2021.

{
    "created_epoch": "1618444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1366023988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 BROOKMEADOW NORTH LN SW APT 2",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494183282",
            "telephone_number": "616-334-1309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 ALPINE AVE NW",
            "city": "COMSTOCK PARK",
            "state": "MI",
            "postal_code": "493218350",
            "telephone_number": "616-784-1619",
            "fax_number": "616-784-2454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLAASSEN",
        "first_name": "VICKY",
        "middle_name": "LYNNE",
        "credential": "CPHT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-15",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "MI",
            "license": "5303002666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Comstock Park, MI · Pharmacy Technician in Michigan