FULLER AVENUE PHARMACY (NPI# 1922109214) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922109214 |
| Entity Type | Organization |
| Organization Name | FULLER AVENUE PHARMACY |
| Practice Address |
2355 Fuller Ave Ne Grand Rapids MI 49505-4367 |
| Practice Telephone | 6163633889 |
| Mailing Telephone | 6163633889 |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JACK ALMASSIAN (OWNER) |
| Authorized Official Telephone | 6163633889 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
5301002349 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | STATE LICENSE NUMBER | 5301002349 | 01 |
| Street Address |
2355 FULLER AVE NE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49505-4367 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821199191 | Jack Almassian | Pharmacist | 2355 Fuller Ave Ne, Grand Rapids, MI 49505-4367 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285276097 | Molly Beth Kerkstra | Home Health Aide | 1115 Ball Ave Nw, Grand Rapids, MI 49505 | 2019-10-14 |
| 1154849677 | Roshawn Nichol Whitley | Technician | 891 Maryland Ave, Grand Rapids, MI 49505 | 2017-09-05 |
| 1447778923 | Kelly Benzin-brinks | Social Worker | 1965 3 Mile Rd Ne, Grand Rapids, MI 49505 | 2017-09-05 |
| 1033560404 | Taylor Nolan Boyd | Speech-Language Pathologist | 400 Ann St Ne Ste 106a, Grand Rapids, MI 49505 | 2016-06-28 |
| 1023465002 | Calvin Athy | Counselor | 1101 Ballave Ne, Grand Rapids, MI 49505 | 2016-05-19 |
| 1821456682 | Kelly Van Huisen | Counselor | 1115 Ball Avenue Ne, Building B, Grand Rapids, MI 49505 | 2016-02-08 |
| 1780051102 | Mark Squeteri | Social Worker | 1345 Monroe Ave Nw Ste 234, Grand Rapids, MI 49505 | 2015-09-02 |
| 1346637337 | Shelby Fullington | Social Worker | 1011 Ball Ave Ne, Grand Rapids, MI 49505 | 2015-04-17 |
| 1457745325 | Lester Anderson II | Social Worker | 1115 Ball Ave, Grand Rapids, MI 49505 | 2015-03-27 |
| 1730570151 | Nicole Brown | Counselor | 1345 Monroe Ave Nw Ste 204, Grand Rapids, MI 49505 | 2015-02-06 |
| Find all providers in zip 49505 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518504091 | East Paris Pharmacy, LLC | Pharmacy | 2060 E Paris Ave Se Ste 102, Grand Rapids, MI 49546-6113 | 2019-12-04 |
| 1588229058 | Grand Rapids Rx LLC | Pharmacy | 1000 E Paris Ave Se Ste 104, Grand Rapids, MI 49546-3680 | 2019-05-09 |
| 1073950994 | Cet Pharmacy Grand Rapids LLC | Pharmacy | 2060 E Paris Ave Se Ste 110, Grand Rapids, MI 49546-6113 | 2013-06-01 |
| 1619209004 | Family Fare, LLC | Pharmacy | 2022 Apple Orchard Dr Ne, Grand Rapids, MI 49525-9785 | 2010-02-10 |
| 1235257387 | Cancer and Hematology Centers of Western Mi, P.C. | Pharmacy | 145 Michigan Ave Ne, Suite 3100, Grand Rapids, MI 49503 | 2007-03-27 |
| 1720160518 | Nudak Ventures LLC | Pharmacy | 417 Nw 1st Ave, Grand Rapids, MN 55744-2617 | 2006-10-20 |
| 1871693218 | Woodward Detroit Cvs, L.L.C. | Pharmacy | 1155 Fuller Ave Ne, Grand Rapids, MI 49503-1362 | 2006-09-25 |
| 1114027448 | Family Fare, LLC | Pharmacy | 1225 Leonard St Ne, Grand Rapids, MI 49505-5510 | 2006-09-25 |
| 1760582092 | Family Fare, LLC | Pharmacy | 5241 Northland Dr Ne, Grand Rapids, MI 49525-1041 | 2006-09-25 |
| 1679673909 | Family Fare, LLC | Pharmacy | 2755 Lake Michigan Dr Nw, Grand Rapids, MI 49504-5872 | 2006-09-25 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49505 |
Please comment or provide details below to improve the information on FULLER AVENUE PHARMACY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.