Active NPI
Courtlyn Miedema
- Pharmacist
- Byron Center, MI
National Provider Identifier
1578285227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302414682
- Practice address
- 8364 Byron Center Ave SW
Byron Center, MI 49315-7805 - Phone
- (616) 878-0497
- NPI assigned
- Sep 19, 2022
- Sex
- Female
- 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 | 5302414682 | MI | Primary |
Addresses
Primary practice location
8364 Byron Center Ave SW
Byron Center, MI 49315-7805
Mailing address
8364 Byron Center Ave SW
Byron Center, MI 49315-7805
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 |
|---|---|---|---|
| 5302414682 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
8364 Byron Center Ave SW
Byron Center, MI 49315
Phone (616) 878-0497
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663545600000",
"number": "1578285227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8364 BYRON CENTER AVE SW",
"city": "BYRON CENTER",
"state": "MI",
"postal_code": "493157805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8364 BYRON CENTER AVE SW",
"city": "BYRON CENTER",
"state": "MI",
"postal_code": "493157805",
"telephone_number": "616-878-0497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIEDEMA",
"first_name": "COURTLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-19",
"last_updated": "2022-09-19",
"certification_date": "2022-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302414682",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Byron Center, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.