NPIMap

Organization Active NPI

Macdonald Drug Store Inc

  • Community/Retail Pharmacy
  • South Haven, MI
National Provider Identifier
1437105293
Registry record updated May 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301002169 Issued in MI
Legal business name
MACDONALD DRUG STORE INC
Practice address
512 Phoenix St
South Haven, MI 49090-1443
Phone
(269) 637-1161
Fax
(269) 639-2524
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2016

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

Authorized official

Name
Kelly Soekarmoen, RPHNPI 1598990525
Title
Owner
Phone
(269) 649-1476

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301002169 MI Primary

Addresses

Primary practice location

512 Phoenix St
South Haven, MI 49090-1443

Mailing address

110 S Main St
Vicksburg, MI 49097-1211
Phone (269) 649-1476

Other identifiers 2

IdentifierTypeStateIssuer
871982298MedicaidMI
2041741OtherPK

Other names 1

  • MACDONALD DRUG STORE INC Doing business as

National Provider Directory

National Provider Directory

Locations

512 Phoenix St
South Haven, MI 49090
Phone (269) 637-1161

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1437105293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 S MAIN ST",
            "city": "VICKSBURG",
            "state": "MI",
            "postal_code": "490971211",
            "telephone_number": "269-649-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 PHOENIX ST",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490901443",
            "telephone_number": "269-637-1161",
            "fax_number": "269-639-2524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACDONALD DRUG STORE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "SOEKARMOEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-649-1476",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301002169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "871982298",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2041741",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MACDONALD DRUG STORE INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; 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.