Individual provider Active NPI

Thomas Lee Sandison, R.PH.

  • Pharmacist
  • Petoskey, MI
National Provider Identifier
1962427401
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302026140 Issued in MI
Practice address
1250 Lears Rd
Petoskey, MI 49770-9252
Phone
(231) 242-1667
Fax
(231) 242-1667
NPI assigned
Jul 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302026140 MI Primary

Addresses

Primary practice location

1250 Lears Rd
Petoskey, MI 49770-9252

Mailing address

12955 Robins Ridge Rd
Charlevoix, MI 49720-8974
Phone (231) 547-5280

Other practice location 1

601 Bridge St
East Jordan, MI 49727-9383
Phone (231) 536-2207

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

LicenseStateTypeSpecialty
5302026140MIMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1962427401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12955 ROBINS RIDGE RD",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497208974",
            "telephone_number": "231-547-5280",
            "fax_number": "231-536-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 LEARS RD",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497709252",
            "telephone_number": "231-242-1667",
            "fax_number": "231-242-1667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Bridge St",
            "address_purpose": "LOCATION",
            "city": "East Jordan",
            "state": "MI",
            "postal_code": "497279383",
            "country_code": "US",
            "telephone_number": "231-536-2207",
            "fax_number": "231-536-7739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDISON",
        "first_name": "THOMAS",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "R.PH.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302026140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.

Verify at the official NPI Registry.