Northgate Pharmacy

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5301007690 Issued in MI

Legal business name

NORTHGATE PHARMACY

Practice address

721 N Van Dyke Rd
Bad Axe, MI 48413-9188

Phone

(989) 269-8061

Fax

(989) 269-2094

NPI assigned

May 12, 2006

Last updated

Mar 30, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jon Volk, RPH

Title

Owner

Phone

(989) 269-8061

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238371200000",
    "number": "1528019072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 N VAN DYKE RD",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139188",
            "telephone_number": "989-269-8061",
            "fax_number": "989-269-9189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 N VAN DYKE RD",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139188",
            "telephone_number": "989-269-8061",
            "fax_number": "989-269-2094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHGATE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2009-03-30",
        "status": "A",
        "authorized_official_last_name": "VOLK",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-269-8061",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "5301007690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "540C210260",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "874741850",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Bad Axe, MI
• Providers in Bad Axe, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; 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.