Active NPI
Austin Tiemersma, PHARMD
- Pharmacist
- Gaylord, MI
National Provider Identifier
1992344428
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302411910
- Practice address
- 950 Edelweiss Village Pkwy
Gaylord, MI 49735-7441 - Phone
- (989) 732-8998
- NPI assigned
- Jan 1, 2020
- Last updated
- Jan 9, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 5302411910 | MI | Primary |
Addresses
Primary practice location
950 Edelweiss Village Pkwy
Gaylord, MI 49735-7441
Mailing address
950 Edelweiss Village Pkwy
Gaylord, MI 49735-7441
Phone (708) 843-3264
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 |
|---|---|---|---|
| 5302411910 | MI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578528000000",
"number": "1992344428",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 EDELWEISS VILLAGE PKWY",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497357441",
"telephone_number": "708-843-3264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "950 EDELWEISS VILLAGE PKWY",
"city": "GAYLORD",
"state": "MI",
"postal_code": "497357441",
"telephone_number": "989-732-8998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIEMERSMA",
"first_name": "AUSTIN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-01",
"last_updated": "2020-01-09",
"certification_date": "2020-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302411910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gaylord, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.