Active NPI
Michael Alfred Vanwasshenova, PHARMD
- Pharmacist
- Monroe, MI
National Provider Identifier
1457985780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302032982
- Practice address
- 919 S Monroe St
Monroe, MI 48161-1442 - Phone
- (734) 384-9559
- Fax
- (734) 384-5597
- NPI assigned
- Feb 25, 2020
- Last updated
- Feb 25, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 5302032982 | MI | Primary |
Addresses
Primary practice location
919 S Monroe St
Monroe, MI 48161-1442
Mailing address
919 S Monroe St
Monroe, MI 48161-1442
Phone (734) 384-9559
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 |
|---|---|---|---|
| 5302032982 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582588800000",
"number": "1457985780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 S MONROE ST",
"city": "MONROE",
"state": "MI",
"postal_code": "481611442",
"telephone_number": "734-384-9559",
"fax_number": "734-384-5597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "919 S MONROE ST",
"city": "MONROE",
"state": "MI",
"postal_code": "481611442",
"telephone_number": "734-384-9559",
"fax_number": "734-384-5597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWASSHENOVA",
"first_name": "MICHAEL",
"middle_name": "ALFRED",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-25",
"last_updated": "2020-02-25",
"certification_date": "2020-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302032982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.