Active NPI
Taylor Thomas Waidelich, PHARM.D.
- Pharmacist
- Benton Harbor, MI
National Provider Identifier
1962788901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302040666
- Practice address
- 875 E Napier Ave
Benton Harbor, MI 49022-6125 - Phone
- (269) 983-3463
- NPI assigned
- Oct 21, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302040666 | MI | Primary |
| Pharmacist | 183500000X | 051.294936 | IL |
Addresses
Primary practice location
875 E Napier Ave
Benton Harbor, MI 49022-6125
Mailing address
2940 Pagoda Path
Stevensville, MI 49127-9327
Phone (715) 216-4292
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 |
|---|---|---|---|
| 051.294936 | IL | MD | Pharmacist |
| 5302040666 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pharmacy
- Benton Harbor, MI
- NPI 1275548380
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1962788901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2940 PAGODA PATH",
"city": "STEVENSVILLE",
"state": "MI",
"postal_code": "491279327",
"telephone_number": "715-216-4292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "875 E NAPIER AVE",
"city": "BENTON HARBOR",
"state": "MI",
"postal_code": "490226125",
"telephone_number": "269-983-3463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAIDELICH",
"first_name": "TAYLOR",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-21",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302040666",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.294936",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benton Harbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.