IndividualActive
Kent Dickerson, RPH
NPI 1104146596 · Pharmacist · Grand Rapids, MI
Provider details
- NPI number
- 1104146596
- Entity type
- Individual
- Primary specialty
- PharmacistPharmacy Service Providers
- Credential
- RPH
- Sex
- Male
- Sole proprietor
- No
- License
- 5302031457 (MI)
Specialties & taxonomies
Pharmacy Service Providers
Profile Score
Detailed profile(83/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2036 Lake Michigan Dr Nw
Grand Rapids, MI 49504-4743
Phone: (616) 453-8750
Fax: (616) 453-0107
Street-level locationGet directions
Mailing address
2036 Lake Michigan Dr Nw
Grand Rapids, MI 49504-4743
Registry dates
- Enumerated
- 2010-06-08
- Last updated
- 2010-06-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.