Tiffany Sue Callicoat, PHARMD
Individual provider Active NPI Pharmacist · Davison, MI
NPI 1922729110 · NPPES record last updated Sep 7, 2022
Key facts
- NPI
- 1922729110
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302413715 (MI)
- Practice address
- 700 N State Rd
Davison, MI 48423-1130 - Phone
- (810) 658-8051
- NPI assigned
- Sep 7, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302413715 | MI | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J220793778797 | Other | MI | DRIVERS LICENSE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tiffany.jacques@stores.com |
Other providers in Davison, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.