Jessica Prociv, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

5302037973 Issued in MI

Practice address

6938 Elm Valley Dr Ste 101
Kalamazoo, MI 49009-7438

Phone

(269) 552-4167

Fax

(269) 552-4216

NPI assigned

Sep 28, 2011

Last updated

Dec 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1861776627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3928 N ROSEBUD DR SE",
            "address_2": "APT #8",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495129404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6938 ELM VALLEY DR STE 101",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490097438",
            "telephone_number": "269-552-4167",
            "fax_number": "269-552-4216"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3300 W Centre Ave",
            "address_purpose": "LOCATION",
            "city": "Portage",
            "state": "MI",
            "postal_code": "490244666",
            "country_code": "US",
            "telephone_number": "269-552-4167",
            "fax_number": "269-324-2134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROCIV",
        "first_name": "JESSICA",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-28",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "MI",
            "license": "5302037973",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302037973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MICHIGAN BOARD OF PHARMACY",
            "identifier": "5302037973",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Kalamazoo, MI
• Providers in Kalamazoo, MI by specialty
• Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.