Active NPI
Cory Jon Driesenga, RPH
- Pharmacist
- Kentwood, MI
National Provider Identifier
1881376259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302415311
- Practice address
- 5225 Eastern Ave SE
Kentwood, MI 49508-6009 - Phone
- (616) 261-3662
- NPI assigned
- Aug 3, 2023
- Sex
- Male
- 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 | 5302415311 | MI | Primary |
Addresses
Primary practice location
5225 Eastern Ave SE
Kentwood, MI 49508-6009
Mailing address
6681 E Mill Run SE
Caledonia, MI 49316-9157
Phone (616) 212-3975
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 |
|---|---|---|---|
| 5302415311 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691020800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691020800000",
"number": "1881376259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6681 E MILL RUN SE",
"city": "CALEDONIA",
"state": "MI",
"postal_code": "493169157",
"telephone_number": "616-212-3975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5225 EASTERN AVE SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495086009",
"telephone_number": "616-261-3662"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRIESENGA",
"first_name": "CORY",
"middle_name": "JON",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-03",
"last_updated": "2023-08-03",
"certification_date": "2023-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302415311",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kentwood, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.