John S Burgess, RPH
Individual provider Active NPI Pharmacist · Niles, MI
NPI 1639766561 · NPPES record last updated Dec 27, 2020
Key facts
- NPI
- 1639766561
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302029361 (MI)
- Practice address
- 720 S 11TH St
Niles, MI 49120-3313 - Phone
- (269) 684-1418
- Fax
- (269) 684-1457
- NPI assigned
- Dec 27, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302029361 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Martin'S Super Markets of Niles LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302029361 | MI | Yes |
Addresses
Primary practice location
720 S 11TH St
Niles, MI 49120-3313
Mailing address
720 S 11TH St
Niles, MI 49120-3313
Phone (269) 686-1418
Other providers in Niles, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.