Kimalyn Sue Averill, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302030463 Issued in MI

Practice address

3191 28TH St SW
Grandville, MI 49418-1110

Phone

(616) 534-5533

Fax

(616) 534-2205

NPI assigned

Aug 25, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Grandville, MI
  • NPI 1528073632
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314230400000",
    "number": "1376823005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2281 BRIDLE CREEK ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495080957",
            "telephone_number": "616-745-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3191 28TH ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181110",
            "telephone_number": "616-534-5533",
            "fax_number": "616-534-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVERILL",
        "first_name": "KIMALYN",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-25",
        "last_updated": "2011-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302030463",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS42372",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aspen Dental of Michigan PC
• Athletico LTD
• Whitney Atkinson
• Ann M Auburn, D.O.
• Michelle Katherine Aue, PA-C
• Mary D Ayers, MA, LLC
• Maha Baalbaki, PHD
• Neidaly Babcock
• Margaret Elizabeth Bader, FNP
• Autumn N Bahlke, LMT

• All providers in Grandville, MI
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.

Verify at the official NPI Registry.