1215160577 NPI number — JODI RANEE MAKI R.PH., PHARM.D.

Table of content: JODI RANEE MAKI R.PH., PHARM.D. (NPI 1215160577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215160577 NPI number — JODI RANEE MAKI R.PH., PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAKI
Provider First Name:
JODI
Provider Middle Name:
RANEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.PH., PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANDERSALL
Provider Other First Name:
JODI
Provider Other Middle Name:
RANEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.PH., PHARM.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215160577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14111 WHITE CREEK AVE NE STE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR SPRINGS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49319-8170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-439-2779
Provider Business Mailing Address Fax Number:
616-439-2552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14111 WHITE CREEK AVE NE STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR SPRINGS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49319-8170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-439-2779
Provider Business Practice Location Address Fax Number:
616-439-2552
Provider Enumeration Date:
09/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5302033111 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)