Jaclyn Anderson, RPH
Individual provider Active NPI Pharmacist · Muskegon HTS, MI
NPI 1699295113 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1699295113
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302026830 (MI)
- Practice address
- 2700 Baker St Ste 3a
Muskegon HTS, MI 49444-2157 - Phone
- (231) 737-9510
- NPI assigned
- Jun 26, 2017
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 5302026830 | MI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302026830 | MI | Yes |
Addresses
Primary practice location
2700 Baker St Ste 3a
Muskegon HTS, MI 49444-2157
Mailing address
2700 Baker St Ste 3a
Muskegon HTS, MI 49444-2157
Phone (231) 737-9510
Other providers in Muskegon HTS, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. 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.