Active NPI
Jonathan Victor Van Lare, PHARM. D.
- Pharmacist
- Southfield, MI
National Provider Identifier
1952520462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302035070
- Practice address
- 22777 W 11 Mile Rd
Southfield, MI 48034-2152 - Phone
- (248) 358-9160
- NPI assigned
- Apr 24, 2007
- 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 | 5302035070 | MI | Primary |
Addresses
Primary practice location
22777 W 11 Mile Rd
Southfield, MI 48034-2152
Mailing address
1393 Moy Avenue
Windsor, ONTARIO N8X 4S5
CA
Phone (519) 253-0605
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 |
|---|---|---|---|
| 5302035070 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952520462",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "1393 MOY AVENUE",
"city": "WINDSOR",
"state": "ONTARIO",
"postal_code": "N8X 4S5",
"telephone_number": "519-253-0605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22777 W 11 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480342152",
"telephone_number": "248-358-9160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN LARE",
"first_name": "JONATHAN",
"middle_name": "VICTOR",
"name_prefix": "Mr.",
"credential": "PHARM. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302035070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.