Active NPI
Stacy Bosch, RPH
- Pharmacist
- Newaygo, MI
National Provider Identifier
1376884403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302030949
- Practice address
- 91 W Pine Lake Dr
Newaygo, MI 49337-9331 - Phone
- (231) 652-9484
- Fax
- (231) 652-9485
- NPI assigned
- Mar 14, 2013
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302030949 | MI | Primary |
Addresses
Primary practice location
91 W Pine Lake Dr
Newaygo, MI 49337-9331
Mailing address
91 W Pine Lake Dr
Newaygo, MI 49337-9331
Phone (231) 652-9484
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5302030949 | Other | MI | REGISTERED PHARMACIST PERMANENT I.D. NUMBER |
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 |
|---|---|---|---|
| 5302030949 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363219200000",
"number": "1376884403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 W PINE LAKE DR",
"city": "NEWAYGO",
"state": "MI",
"postal_code": "493379331",
"telephone_number": "231-652-9484",
"fax_number": "231-652-9485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91 W PINE LAKE DR",
"city": "NEWAYGO",
"state": "MI",
"postal_code": "493379331",
"telephone_number": "231-652-9484",
"fax_number": "231-652-9485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSCH",
"first_name": "STACY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-14",
"last_updated": "2013-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302030949",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED PHARMACIST PERMANENT I.D. NUMBER",
"identifier": "5302030949",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newaygo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.