Active NPI
Mark Petri
- Community/Retail Pharmacy
- Macomb, MI
National Provider Identifier
1649796368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Practice address
- 49188 Frances Dr
Macomb, MI 48044-1638 - Phone
- (586) 556-1468
- NPI assigned
- Aug 15, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302027576 | MI | |
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
49188 Frances Dr
Macomb, MI 48044-1638
Mailing address
51450 Shelby Pkwy
Shelby TWP, MI 48315-1786
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 |
|---|---|---|---|
| 5302027576 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502755200000",
"number": "1649796368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51450 SHELBY PKWY",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483151786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49188 FRANCES DR",
"city": "MACOMB",
"state": "MI",
"postal_code": "480441638",
"telephone_number": "586-556-1468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRI",
"first_name": "MARK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-15",
"last_updated": "2017-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302027576",
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.