Active NPI
Kurt M Johnson, RPH.
- Pharmacist
- Wyoming, MI
National Provider Identifier
1902808322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302024575
- Practice address
- 2900 Burlingame Ave SW
Wyoming, MI 49509-2610 - Phone
- (616) 538-1490
- NPI assigned
- Aug 15, 2005
- 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 | 5302024575 | MI | Primary |
Addresses
Primary practice location
2900 Burlingame Ave SW
Wyoming, MI 49509-2610
Mailing address
2900 Burlingame Ave SW
Wyoming, MI 49509-2610
Phone (616) 538-1490
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 |
|---|---|---|---|
| 5302024575 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prevos Family Markets LLC | Past | Accepting new patients | |
| Prevos Family Markets LLC | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Wyoming, MI
- NPI 1023177029
-
- Community/Retail Pharmacy
- Battle Creek, MI
- NPI 1881832830
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383609600000",
"number": "1902808322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 BURLINGAME AVE SW",
"city": "WYOMING",
"state": "MI",
"postal_code": "495092610",
"telephone_number": "616-538-1490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 BURLINGAME AVE SW",
"city": "WYOMING",
"state": "MI",
"postal_code": "495092610",
"telephone_number": "616-538-1490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KURT",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "RPH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-15",
"last_updated": "2013-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302024575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyoming, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.