Active NPI
Kyle Joseph Thompson, PHARMD
- Pharmacist
- Grand Haven, MI
National Provider Identifier
1477029320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302411906
- Practice address
- 1309 Sheldon Rd
Grand Haven, MI 49417-2488 - Phone
- (616) 403-5539
- NPI assigned
- Oct 18, 2018
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302411906 | MI | Primary |
Addresses
Primary practice location
1309 Sheldon Rd
Grand Haven, MI 49417-2488
Mailing address
227 Henry Ave SE Apt 3
Grand Rapids, MI 49503-5801
Phone (815) 404-6595
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 |
|---|---|---|---|
| 5302411906 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Isidro II Inc | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Canton, MI
- NPI 1295918274
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632355200000",
"number": "1477029320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "227 HENRY AVE SE APT 3",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495035801",
"telephone_number": "815-404-6595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1309 SHELDON RD",
"city": "GRAND HAVEN",
"state": "MI",
"postal_code": "494172488",
"telephone_number": "616-403-5539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "KYLE",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-18",
"last_updated": "2021-09-23",
"certification_date": "2021-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302411906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Haven, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.