NPIMap

Individual provider Active NPI

Elizabeth Kaitlyn Clark, PHARMD RPH

  • Pharmacist
  • Traverse City, MI
National Provider Identifier
1467076224
Registry record updated Jun 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302039919 Issued in MI
Practice address
1029 S M 37
Traverse City, MI 49685-8508
Phone
(231) 943-3147
NPI assigned
Jun 7, 2020
Last updated
Jun 7, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302039919 MI Primary

Addresses

Primary practice location

1029 S M 37
Traverse City, MI 49685-8508

Mailing address

5477 Exodus Dr
Traverse City, MI 49684-8353
Phone (231) 715-0090

Other names 1

  • Elizabeth Kaitlyn Troost Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Rxm.10186@store.walgreens.com Direct

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, Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
5302039919MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co CurrentSince Mar 6, 2022 Accepting new patients
Walgreen Co PastSince Jun 14, 2020 Accepting new patients

Locations

1029 S M 37
Traverse City, MI 49685
Phone (231) 943-3147

Organizations & group practices 2

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": "1591488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591488000000",
    "number": "1467076224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5477 EXODUS DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848353",
            "telephone_number": "231-715-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 S M 37",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496858508",
            "telephone_number": "231-943-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELIZABETH",
        "middle_name": "KAITLYN",
        "credential": "PHARMD RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-07",
        "last_updated": "2020-06-07",
        "certification_date": "2020-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302039919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Rxm.10186@store.walgreens.com",
            "affiliation": "N",
            "endpointDescription": "Pharmacy work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Work email",
            "address_1": "1029 S M 37",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496858508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "TROOST",
            "middle_name": "KAITLYN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Jun 7, 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.

Verify at the official NPI Registry.