DR. JACK ROBERT HERMANN (NPI# 1063043248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063043248 |
| Entity Type | Individual |
| Full Name | DR. JACK ROBERT HERMANN |
| Credential | PHARMD |
| Practice Address |
727 28th St Se Grand Rapids MI 49548-1303 |
| Practice Telephone | 6165145602 |
| Practice Fax Number | 6162479875 |
| Mailing Telephone | 6165145602 |
| Mailing Fax Number | 6162479875 |
| Enumeration Date | 2020-01-28 |
| Last Update Date | 2020-01-28 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 5302040590 | MI | Pharmacy Service Providers |
| Street Address |
727 28TH ST SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49548-1303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710086012 | Woodward Detroit Cvs LLC | Pharmacy | 727 28th St Se, Grand Rapids, MI 49548-1303 | 2006-09-22 |
| 1487285250 | Susan Bernal | Pharmacist | 727 28th St Se, Grand Rapids, MI 49548-1303 | 2020-01-30 |
| 1518598515 | Joshua Dean Gallup | Pharmacist | 727 28th St Se, Grand Rapids, MI 49548-1303 | 2020-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205319811 | Pooja Patel | Social Worker | Spectrum Community Services, 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2018-09-10 |
| 1063906865 | Kimberly Eccher | Physician Assistant | 300 68th St. Se, Grand Rapids, MI 49548 | 2018-06-15 |
| 1871099481 | Baymark of Michigan, Inc. | Clinic/Center | 5500 Division Avenue Se, Kentwood, MI 49548 | 2018-04-03 |
| 1629507801 | Laura Marie Quennoz | Psychiatry & Neurology | Pine Rest Christian Mental Health Services, 300 68th Street Se, Grand Rapids, MI 49548 | 2017-06-09 |
| 1821548504 | Alison Anderson | Technician, Other | 103 Roth St Se, Grand Rapids, MI 49548 | 2016-10-06 |
| 1831540152 | Jesse Aubil | Counselor | 264 Montebello St. Se 49548, Grand Rapids, MI 49548 | 2016-06-28 |
| 1306237920 | Sarah Benton | Social Worker | 225 Colrain St Sw, 2, Grand Rapids, MI 49548 | 2015-02-18 |
| 1578996856 | Karen Marie Irving | Social Worker | 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2013-08-09 |
| 1740348044 | Robert Kenneth Richmond | Preventive Medicine | 551 36th Street. Se, Wyoming, MI 49548 | 2006-12-05 |
| 1386738953 | Sharita Montiez Hall | Social Worker | 300 68th Street Se, Grand Rapids, MI 49548 | 2006-10-03 |
| Find all providers in zip 49548 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164031860 | Jerika Nguyen | Pharmacist | 525 Clancy Ave Ne Apt 120, Grand Rapids, MI 49503-1843 | 2020-07-28 |
| 1063045177 | Kristen Buthker | Pharmacist | 1021 Alpine Ave Nw, Grand Rapids, MI 49504-4139 | 2020-02-17 |
| 1124667258 | Grant Lawson Beach | Pharmacist | 201 Michigan St Nw Apt 910, Grand Rapids, MI 49503-2330 | 2020-01-07 |
| 1821562844 | Catherine Formalejo Padogdog | Pharmacist | 2051 Ridgecrest Rd Se Apt 7, Grand Rapids, MI 49546-4321 | 2019-01-12 |
| 1386151660 | Brett Donald Jenkins | Pharmacist | 3326 Weatherford Dr Nw Apt 3a, Grand Rapids, MI 49544-6966 | 2018-01-08 |
| 1326568296 | Sarah Ann Kauffman | Pharmacist | 360 Division Ave S Ste 1a, Grand Rapids, MI 49503-4501 | 2017-06-22 |
| 1760920698 | Heidi Catherine Stultz-griffey | Pharmacist | 970 4 Mile Rd Nw Apt 1d, Grand Rapids, MI 49544 | 2017-02-12 |
| 1235585456 | Kirsten Hayes | Pharmacist | 510 College Ave Ne Apt 215, Grand Rapids, MI 49503-1770 | 2016-05-06 |
| 1740649201 | Robert Matthew Granett | Pharmacist | 200 Jefferson Ave Se # See, Grand Rapids, MI 49503-4502 | 2016-02-12 |
| 1386000420 | Samantha Shifman | Pharmacist | 555 7th St Nw, Apt. 208, Grand Rapids, MI 49504-5213 | 2016-01-05 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49548 |
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| 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.