Active NPI
Kimberly Ann Maxam, R.PH.
- Pharmacist
- Schoolcraft, MI
National Provider Identifier
1821379496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302032533
- Practice address
- 139 N Grand St
Schoolcraft, MI 49087-5111 - Phone
- (269) 679-2008
- Fax
- (269) 679-2722
- NPI assigned
- Sep 8, 2011
- Last updated
- Sep 8, 2011
- Sex
- Female
- 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 | 5302032533 | MI | Primary |
Addresses
Primary practice location
139 N Grand St
Schoolcraft, MI 49087-5111
Mailing address
139 N. Grand St., PO Box 399
Schoolcraft, MI 49087-0399
Phone (269) 679-2008
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 |
|---|---|---|---|
| 5302032533 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| R P Glidden Inc | Past | Accepting new patients |
Organizations & group practices 1
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": "1315440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315440000000",
"number": "1821379496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "139 N. GRAND ST., PO BOX 399",
"city": "SCHOOLCRAFT",
"state": "MI",
"postal_code": "490870399",
"telephone_number": "269-679-2008",
"fax_number": "269-679-2722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "139 N GRAND ST",
"city": "SCHOOLCRAFT",
"state": "MI",
"postal_code": "490875111",
"telephone_number": "269-679-2008",
"fax_number": "269-679-2722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXAM",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"name_prefix": "Miss",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-08",
"last_updated": "2011-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302032533",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schoolcraft, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.