Saint Marys Family Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301004226 Issued in MI

Legal business name

SAINT MARYS FAMILY PHARMACY

Practice address

360 Division Ave S
Ste 1a
Grand Rapids, MI 49503-4501

Phone

(616) 685-1147

Fax

(616) 685-1145

NPI assigned

Jun 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Casalou

Title

President/Ceo

Phone

(734) 712-3792

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 2

• MERCY HEALTH PHARMACY-CATHEDRAL SQUARE Doing business as
• Trinity Health Pharmacy - Cathedral Square Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Saint Mary'S Health Services

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057

  Member Of

  NPD member
• Trinity Health - Michigan

  • Community/Retail Pharmacy
  • Ann Arbor, MI
  • NPI 1417029034

  Member Of

  NPD member
• Trinity Health - Michigan

  • Community/Retail Pharmacy
  • Hudsonville, MI
  • NPI 1700351657

  Member Of

  NPD member

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carmen Mitchell Docter, PHARMD

  • Pharmacist
  • Grand Rapids, MI
  • NPI 1235666827
  NPD
• Terry K Kirkpatrick, MS, RPH

  • Pharmacist
  • Grand Rapids, MI
  • NPI 1821070087
  NPD
• Sara Buikema

  • Pharmacy Technician
  • Grand Rapids, MI
  • NPI 1952163156
  NPD (past)
• Jessica Gren

  • Pharmacy Technician
  • Grand Rapids, MI
  • NPI 1831951029
  NPD (past)
• Sarah Ann Kauffman, RPH

  • Pharmacist
  • Grand Rapids, MI
  • NPI 1326568296
  NPD (past)

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1679519581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 DIVISION AVE S",
            "address_2": "STE 1A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034501",
            "telephone_number": "616-685-1147",
            "fax_number": "616-685-1145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 DIVISION AVE S",
            "address_2": "STE 1A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034501",
            "telephone_number": "616-685-1147",
            "fax_number": "616-685-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT MARYS FAMILY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "CASALOU",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "734-712-3792"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301004226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2045998",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679519581",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4825146",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY HEALTH PHARMACY-CATHEDRAL SQUARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trinity Health Pharmacy - Cathedral Square",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Saint Mary'S Health Services
• Saint Mary'S Health Services
• Saint Mary'S Health Services
• Saint Mary'S Hospital
• Saint Mary'S Hospital
• Saint Marys Family Pharmacy-Wege Center
• Saint Marys Home Infusion Program
• Keerthi Kiran Sajja, DO
• Bushra Sajjad, M.D.
• Sarah Sak-Smith

• All providers in Grand Rapids, MI
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.