Active NPI
Benjamin Jacob Demongey, PHARM D
- Nutrition Support Pharmacist
- Traverse City, MI
National Provider Identifier
1447416193
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Support Pharmacist
- License
- 5302033882
- Practice address
- 1105 Sixth St
Traverse City, MI 49684-2345 - Phone
- (231) 935-6598
- NPI assigned
- Aug 1, 2008
- Last updated
- Aug 1, 2008
- 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 |
|---|---|---|---|---|
| Nutrition Support Pharmacist | 1835N1003X | 5302033882 | MI | Primary |
Addresses
Primary practice location
1105 Sixth St
Traverse City, MI 49684-2345
Mailing address
3883 Central Park Dr
Grawn, MI 49637-9721
Phone (231) 409-0168
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 |
|---|---|---|---|
| 5302033882 | MI | MD | Nutrition Support Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217548800000",
"number": "1447416193",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3883 CENTRAL PARK DR",
"city": "GRAWN",
"state": "MI",
"postal_code": "496379721",
"telephone_number": "231-409-0168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 SIXTH ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842345",
"telephone_number": "231-935-6598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMONGEY",
"first_name": "BENJAMIN",
"middle_name": "JACOB",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-01",
"last_updated": "2008-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "1835N1003X",
"taxonomy_group": "",
"desc": "Pharmacist, Nutrition Support",
"state": "MI",
"license": "5302033882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.