Active NPI
Tiffany Sue Callicoat, PHARMD
- Pharmacist
- Davison, MI
National Provider Identifier
1922729110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302413715
- Practice address
- 700 N State Rd
Davison, MI 48423-1130 - Phone
- (810) 658-8051
- NPI assigned
- Sep 7, 2022
- Last updated
- Sep 7, 2022
- Sex
- Female
- 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 | 5302413715 | MI | Primary |
Addresses
Primary practice location
700 N State Rd
Davison, MI 48423-1130
Mailing address
700 N State Rd
Davison, MI 48423-1130
Phone (810) 658-8051
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tiffany.jacques@stores.com |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 5302413715 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Co of Michigan | Current | Accepting new patients | |
| Kroger Co of Michigan | Past | Accepting new patients |
Locations
700 N State Rd
Davison, MI 48423
Phone (810) 658-8051
Interoperability endpoints
- tiffany.jacques@stores.com
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": "1662508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1922729110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 N STATE RD",
"city": "DAVISON",
"state": "MI",
"postal_code": "484231130",
"telephone_number": "810-658-8051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 N STATE RD",
"city": "DAVISON",
"state": "MI",
"postal_code": "484231130",
"telephone_number": "810-658-8051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CALLICOAT",
"first_name": "TIFFANY",
"middle_name": "SUE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-07",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302413715",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tiffany.jacques@stores.com",
"affiliation": "N",
"address_1": "700 N State Rd",
"city": "Davison",
"state": "MI",
"country_code": "US",
"postal_code": "484231130",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Davison, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.