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KEVIN MICHAEL DERIDDER PHARM.D
NPI 1417236514
Pharmacist in Grand Rapids, MI

Active since August 08, 2011
5859 28TH ST SE, GRAND RAPIDS, MI 49546(616) 949-9892 Get Directions Write a Review

NPPES record last updated: September 17, 2024. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Sep 17, 2024, Aug 21, 2019 (2 updates tracked since 2019).

About Kevin Michael Deridder Pharm.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEVIN MICHAEL DERIDDER PHARM.D (NPI 1417236514) is an individual pharmacist in Grand Rapids, Michigan, licensed in Michigan (5302038129) and active in the NPI registry since August 2011.

NPPES Registry Identity

NPI1417236514
Entity TypeIndividualMale
Primary Taxonomy183500000X
Provider Legal NameKEVIN MICHAEL DERIDDERCredential: PHARM.D
Location Address5859 28TH ST SEGrand Rapids, MI 49546-6905
Mailing Address6233 Blakely Dr NeRockford, MI 49341-9611
Phone(616) 949-9892
Sole ProprietorNo
Enumeration DateAugust 8, 2011
Last NPPES UpdateSeptember 17, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 17, 2024
✔ NPI 1417236514 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacistPharmacy Service Providers
Taxonomy Code183500000X
License✔ Licensed in MI · 5302038129
Definition
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.
5859 28TH ST SE, Grand Rapids, MI 49546
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Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WAL-MART STORES EAST, LP
Eyewear Supplier
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-7670
MR. ROBERT B WITHAM RPH
Pharmacist
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-9892
LAURA SUE SMITH RPH
Pharmacist
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-9892
WAL-MART STORES EAST LP
Pharmacy (Community/Retail Pharmacy)
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-9892
MR. HISHAM N SAHOM RPH
Pharmacist
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-9892
CHRISTOPHER KOWALSKI PHARM.D.
Pharmacist
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (970) 404-0576
REBECCA J COLBURN
Optometrist
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-5125
DR. REBECCA J COLBURN O.D.
Optometrist
5859 28TH ST SE
GRAND RAPIDS, MI 49546
Kent County (616) 949-5125

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kevin Deridder's NPI number?

The NPI number for Kevin Deridder is 1417236514. It was assigned to this individual provider in the NPPES registry on August 8, 2011.

Where is Kevin Deridder located?

Kevin Deridder practices at 5859 28th St SE, Grand Rapids, MI 49546. The listed phone number is (616) 949-9892.

What is Kevin Deridder's specialty?

The primary specialty registered for this NPI is Pharmacist with taxonomy code 183500000X.

When was this NPI record last updated?

The NPPES record for Kevin Deridder was last updated on September 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.