Kentwood Pharmacy

Primary specialty

PharmacistTaxonomy code 183500000X

License

5301007344 Issued in MI

Legal business name

KENTWOOD PHARMACY

Practice address

6680 Kalamazoo Ave SE
Grand Rapids, MI 49508-7030

Phone

(616) 554-1964

Fax

(616) 554-3140

NPI assigned

Aug 24, 2006

Last updated

Feb 27, 2008By 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. Kim Mulder

Title

Owner

Phone

(616) 827-9100

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Nelson Verhage, RPH

  • Pharmacist
  • Grand Rapids, MI
  • NPI 1114137882
  NPD (past)

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204070400000",
    "number": "1558478610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6680 KALAMAZOO AVENUE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49508",
            "telephone_number": "616-554-1964",
            "fax_number": "616-554-3140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6680 KALAMAZOO AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495087030",
            "telephone_number": "616-554-1964",
            "fax_number": "616-554-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTWOOD PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2008-02-27",
        "status": "A",
        "authorized_official_last_name": "MULDER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-827-9100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5301007344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200288790",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2362349",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Siobhan Mairead Kent, PA-C
• Tiffany Lauren Kent, MD, PHD
• Kentwood Dental Associates (Dental Associates of West Michigan)
• Kentwood Family Chiropractic, LLC
• Kentwood Family Physicians PC
• Kentwood Pharmacy LLC
• Chris L Kenward, MSW
• Carol Kenworthy
• Abigail Anne Kenyon
• Breeanne Kenyon, PA-C

• Pharmacist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; 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.