Provider Demographics
NPI:1700512464
Name:REDMOND, NIKOTA DANIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:NIKOTA
Middle Name:DANIEL
Last Name:REDMOND
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 BARAGA ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1803
Mailing Address - Country:US
Mailing Address - Phone:517-852-4296
Mailing Address - Fax:
Practice Address - Street 1:2425 ALPINE AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1956
Practice Address - Country:US
Practice Address - Phone:616-365-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2025-07-25
Deactivation Date:2023-07-27
Deactivation Code:
Reactivation Date:2025-07-25
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program