Active NPI
Kamah Ellena
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Grand Rapids, MI
National Provider Identifier
1669099560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 5302412780
- Practice address
- 200 Jefferson Ave SE
Grand Rapids, MI 49503-4502 - Phone
- (616) 685-5306
- NPI assigned
- Jun 26, 2020
- 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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 5302412780 | MI | Primary |
Addresses
Primary practice location
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Mailing address
501 N Bowery Ave
Gladwin, MI 48624-1411
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 |
|---|---|---|---|
| 5302412780 | MI | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595289600000",
"number": "1669099560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 N BOWERY AVE",
"city": "GLADWIN",
"state": "MI",
"postal_code": "486241411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 JEFFERSON AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034502",
"telephone_number": "616-685-5306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLENA",
"first_name": "KAMAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-26",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MI",
"license": "5302412780",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.