Active NPI
Kerry Briske, RPH
- Pharmacist
- Wyoming, MI
National Provider Identifier
1508287293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302026104
- Practice address
- 5500 Clyde Park Ave SW
Wyoming, MI 49509-9525 - Phone
- (616) 530-7133
- Fax
- (616) 530-7165
- NPI assigned
- Dec 23, 2013
- 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 | 5302026104 | MI | Primary |
Addresses
Primary practice location
5500 Clyde Park Ave SW
Wyoming, MI 49509-9525
Mailing address
5500 Clyde Park Ave SW
Wyoming, MI 49509-9525
Phone (616) 530-7133
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5302026104 | Other | MI | PHARMACY LICENSE NUMBER |
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302026104 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387756800000",
"number": "1508287293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5500 CLYDE PARK AVE SW",
"city": "WYOMING",
"state": "MI",
"postal_code": "495099525",
"telephone_number": "616-530-7133",
"fax_number": "616-530-7165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 CLYDE PARK AVE SW",
"city": "WYOMING",
"state": "MI",
"postal_code": "495099525",
"telephone_number": "616-530-7133",
"fax_number": "616-530-7165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRISKE",
"first_name": "KERRY",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-12-23",
"last_updated": "2013-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302026104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACY LICENSE NUMBER",
"identifier": "5302026104",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wyoming, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.