Active NPI
Michelle Lynn Boahbedason
- Pharmacist
- Grand Rapids, MI
National Provider Identifier
1497033732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302029415
- Practice address
- 4252 Kalamazoo Ave SE
Grand Rapids, MI 49508-3607 - Phone
- (616) 281-1323
- Fax
- (616) 281-1330
- NPI assigned
- Aug 3, 2011
- Last updated
- Jan 12, 2023
- Sex
- Female
- 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 | 5302029415 | MI | Primary |
Addresses
Primary practice location
4252 Kalamazoo Ave SE
Grand Rapids, MI 49508-3607
Mailing address
3191 28TH St SW
Grandville, MI 49418-1110
Phone (616) 534-5533
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302029415 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
3191 28th St SW
Grandville, MI 49418
Phone (616) 534-5533
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": "1312329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673481600000",
"number": "1497033732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3191 28TH ST SW",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494181110",
"telephone_number": "616-534-5533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4252 KALAMAZOO AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495083607",
"telephone_number": "616-281-1323",
"fax_number": "616-281-1330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOAHBEDASON",
"first_name": "MICHELLE",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-03",
"last_updated": "2023-01-12",
"certification_date": "2023-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302029415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.