Organization Active NPI

Family Fare, LLC

Doing business as Family Fare Pharmacy 339

  • Pharmacy
  • Grand Rapids, MI
National Provider Identifier
1679673909
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
5301007082 Issued in MI
Legal business name
FAMILY FARE, LLC
Doing business as
Family Fare Pharmacy 339
Practice address
2755 Lake Michigan Dr NW
Grand Rapids, MI 49504-5872
Phone
(616) 791-4777
Fax
(616) 791-8110
NPI assigned
Sep 25, 2006
Last updated
Dec 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Amy Ellis
Title
Director of Pharmacy
Phone
(616) 878-2848

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 5301007082 MI Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

2755 Lake Michigan Dr NW
Grand Rapids, MI 49504-5872

Mailing address

1527 Momentum PL
Spartan Pharmacy North
Chicago, IL 60689-5315
Phone (616) 878-8584

Other identifiers 2

IdentifierTypeStateIssuer
4147323MedicaidMI
2345456OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • FAMILY FARE PHARMACY 339 Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2084485Family Fare Pharmacy #3392755 Lake Michigan Drive NW, Grand Rapids, MI 49504Certificate of waiverSep 23, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1679673909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1527 MOMENTUM PL",
            "address_2": "SPARTAN PHARMACY NORTH",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895315",
            "telephone_number": "616-878-8584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 LAKE MICHIGAN DR NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495045872",
            "telephone_number": "616-791-4777",
            "fax_number": "616-791-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY FARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-07",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "616-878-2848"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MI",
            "license": "5301007082",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4147323",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2345456",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY FARE PHARMACY 339",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAMILY FARE PHARMACY 339",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.