Active NPI
Kenny Ray Walkup Jr., RPH
- Pharmacist
- South Lyon, MI
National Provider Identifier
1942366836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302028789
- Practice address
- 350 S Lafayette St
South Lyon, MI 48178-1814 - Phone
- (248) 446-2643
- Fax
- (248) 486-1906
- NPI assigned
- Dec 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 5302028789 | MI | Primary |
Addresses
Primary practice location
350 S Lafayette St
South Lyon, MI 48178-1814
Mailing address
350 S Lafayette St
South Lyon, MI 48178-1814
Phone (248) 446-2643
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 |
|---|---|---|---|
| 5302028789 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Specialty Medicine Compounding Pharmacy | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Compounding Pharmacy
- South Lyon, MI
- NPI 1083770978
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366329600000",
"number": "1942366836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "350 S LAFAYETTE ST",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481781814",
"telephone_number": "248-446-2643",
"fax_number": "248-486-1906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 S LAFAYETTE ST",
"city": "SOUTH LYON",
"state": "MI",
"postal_code": "481781814",
"telephone_number": "248-446-2643",
"fax_number": "248-486-1906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKUP",
"first_name": "KENNY",
"middle_name": "RAY",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2013-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302028789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lyon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.