Active NPI
Elijah James Kubath, PHARMD
- Pharmacist
- Benton Harbor, MI
National Provider Identifier
1710494067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302411523
- Practice address
- 1920 Pipestone Rd
Benton Harbor, MI 49022-2315 - Phone
- (269) 934-6710
- NPI assigned
- Jan 9, 2018
- Last updated
- Jan 17, 2021
- Sex
- Male
- 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 | 183500000X | 5302411523 | MI | Primary |
Addresses
Primary practice location
1920 Pipestone Rd
Benton Harbor, MI 49022-2315
Mailing address
1920 Pipestone Rd
Benton Harbor, MI 49022-2315
Phone (269) 934-6710
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302411523 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Meijer Inc | Past | Accepting new patients | |
| Meijer Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610841600000",
"number": "1710494067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1920 PIPESTONE RD",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490222315",
"telephone_number": "269-934-6710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 PIPESTONE RD",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490222315",
"telephone_number": "269-934-6710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBATH",
"first_name": "ELIJAH",
"middle_name": "JAMES",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-09",
"last_updated": "2021-01-17",
"certification_date": "2021-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302411523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.