JKP Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301011055 Issued in MI

Legal business name

JKP PHARMACY LLC

Doing business as

Village Pharmacy of Fruitport

Practice address

10 S 3Rd Ave
Fruitport, MI 49415-8945

Phone

(231) 865-3345

Fax

(231) 865-1255

NPI assigned

Nov 21, 2016

Last updated

Jan 8, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James Pancy

Title

Owner

Phone

(231) 865-3345

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Village Pharmacy of Fruitport Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Claire Richardson

  • Pharmacist
  • Manistee, MI
  • NPI 1871303768
  NPD (past)

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546905600000",
    "number": "1922541168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 241",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494150241",
            "telephone_number": "231-865-3345",
            "fax_number": "231-865-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 S 3RD AVE",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494158945",
            "telephone_number": "231-865-3345",
            "fax_number": "231-865-1255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JKP PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-21",
        "last_updated": "2019-01-08",
        "status": "A",
        "authorized_official_last_name": "PANCY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-865-3345"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301011055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922541168",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166727",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Pharmacy of Fruitport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Village Pharmacy of Fruitport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Fruitport, MI
• Providers in Fruitport, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; 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.