Active NPI
Marie Grace De Guzman
- Pharmacist
- Iron Mountain, MI
National Provider Identifier
1962726513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302034304
- Practice address
- 1810 S Stephenson Ave
Iron Mountain, MI 49801-3615 - Phone
- (906) 779-2163
- Fax
- (906) 779-0012
- NPI assigned
- Mar 24, 2010
- Sex
- Female
- 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 | 5302034304 | MI | Primary |
Addresses
Primary practice location
1810 S Stephenson Ave
Iron Mountain, MI 49801-3615
Mailing address
10 Willowbrook CT
Madison, WI 53719-6200
Phone (906) 776-1085
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302034304 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269388800000",
"number": "1962726513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 WILLOWBROOK CT",
"city": "MADISON",
"state": "WI",
"postal_code": "537196200",
"telephone_number": "906-776-1085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1810 S STEPHENSON AVE",
"city": "IRON MOUNTAIN",
"state": "MI",
"postal_code": "498013615",
"telephone_number": "906-779-2163",
"fax_number": "906-779-0012"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE GUZMAN",
"first_name": "MARIE",
"middle_name": "GRACE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-24",
"last_updated": "2010-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302034304",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iron Mountain, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.