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1023447240 NPI number — ZACHARY FETTES PHARM.D RPH

NPI Number: 1023447240
Health Care Provider/Practitioner: ZACHARY FETTES PHARM.D RPH

Information about “1023447240” NPI (ZACHARY FETTES PHARM.D RPH) exists in 1023447240 in HTML format HTML  |  1023447240 in plain Text format TXT  |  1023447240 in PDF (Portable Document Format) PDF  |  1023447240 in an XML format XML  formats.

NPI Number : 1023447240 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023447240",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FETTES",
    "FirstName": "ZACHARY",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARM.D RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2916 TRAPPERS COVE TRL APT 2B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LANSING",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48910-8499",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "269-986-2005",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2055 W GRAND RIVER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OKEMOS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48864-1706",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-349-2930",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/07/2013",
    "LastUpdateDate": "11/07/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "5302037053",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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