Active NPI
Nathan Riedeman, PHARMD
- Pharmacist
- Forest Lake, MN
National Provider Identifier
1003591579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 813773
- Practice address
- 356 12TH St SW
Forest Lake, MN 55025-1749 - Phone
- (651) 464-1994
- NPI assigned
- Jun 21, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 813773 | MN | Primary |
Addresses
Primary practice location
356 12TH St SW
Forest Lake, MN 55025-1749
Mailing address
10130 Julep TRL N
Scandia, MN 55073-9770
Phone (651) 500-5466
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 813773 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687305600000",
"number": "1003591579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10130 JULEP TRL N",
"city": "SCANDIA",
"state": "MN",
"postal_code": "550739770",
"telephone_number": "651-500-5466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "356 12TH ST SW",
"city": "FOREST LAKE",
"state": "MN",
"postal_code": "550251749",
"telephone_number": "651-464-1994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIEDEMAN",
"first_name": "NATHAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-21",
"last_updated": "2023-06-21",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "813773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.