Individual provider Active NPI

Samuel Honderd, PHARMD

  • Pharmacist
  • Coopersville, MI
National Provider Identifier
1831508902
Registry record updated Aug 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302040082 Issued in MI
Practice address
1151 W Randall St
Coopersville, MI 49404-1355
Phone
(616) 837-6219
NPI assigned
Aug 4, 2014
Last updated
Aug 4, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302040082 MI Primary

Addresses

Primary practice location

1151 W Randall St
Coopersville, MI 49404-1355

Mailing address

750 Port Sheldon Rd SW
Grandville, MI 49418-9448
Phone (616) 401-5399

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

LicenseStateTypeSpecialty
5302040082MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Rite Aid of Michigan Inc Past Accepting new patients
Rite Aid of Michigan 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": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407110400000",
    "number": "1831508902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 PORT SHELDON RD SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494189448",
            "telephone_number": "616-401-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 W RANDALL ST",
            "city": "COOPERSVILLE",
            "state": "MI",
            "postal_code": "494041355",
            "telephone_number": "616-837-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HONDERD",
        "first_name": "SAMUEL",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-04",
        "last_updated": "2014-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302040082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coopersville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2014; 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.