Model Drug Store

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301002043 Issued in MI

Legal business name

MODEL DRUG STORE

Practice address

35 W 8TH St
Holland, MI 49423-3102

Phone

(616) 392-4707

Fax

(616) 392-2449

NPI assigned

Aug 12, 2006

Last updated

Mar 24, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sharon Beth Fisher, RPH

Title

Owner

Phone

(616) 392-4707

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1770595670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 W 8TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494233102",
            "telephone_number": "616-392-4707",
            "fax_number": "616-392-2449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 W 8TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494233102",
            "telephone_number": "616-392-4707",
            "fax_number": "616-392-2449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODEL DRUG STORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2009-03-24",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-392-4707",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301002043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2306303",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1697599",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tricia R Miller, MD
• Kelly Charine Minder
• Amanda Mishler, PA-C
• Kimberley Paige Herman Mitchell, MA-CCC/SLP
• Rachel Leanne Mitchell, BASW
• Daniel Scott Molenaar, P.T.
• Ann Monroe, M.D.
• Marla Jeanne Montbriand
• Karen Ardel Monterusso, PA
• Mary Kathryn Mooi, LCSW

• Community/Retail Pharmacy in Holland, MI
• Providers in Holland, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.