Active NPI
Deborah Lynne Kleinbrook, RPH
- Pharmacist
- Grandville, MI
National Provider Identifier
1710587035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302029832
- Practice address
- 4542 Kenowa Ave SW
Grandville, MI 49418-9523 - Phone
- (616) 667-9713
- Fax
- (616) 667-9715
- NPI assigned
- Oct 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 5302029832 | MI | Primary |
Addresses
Primary practice location
4542 Kenowa Ave SW
Grandville, MI 49418-9523
Mailing address
4542 Kenowa Ave SW
Grandville, MI 49418-9523
Phone (616) 667-9713
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302029832 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1710587035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4542 KENOWA AVE SW",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494189523",
"telephone_number": "616-667-9713",
"fax_number": "616-667-9715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4542 KENOWA AVE SW",
"city": "GRANDVILLE",
"state": "MI",
"postal_code": "494189523",
"telephone_number": "616-667-9713",
"fax_number": "616-667-9715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEINBROOK",
"first_name": "DEBORAH",
"middle_name": "LYNNE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-27",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302029832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grandville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.