Elk River Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

265251 Issued in MN

Legal business name

ELK RIVER PHARMACY

Practice address

323 Jackson Ave NW
Elk River, MN 55330

Phone

(763) 441-1353

NPI assigned

Jul 13, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deborah Leedahl, PHARMDNPI 1043361249

Title

President

Phone

(763) 441-1353

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deborah Leedahl, PHARMD

  • Pharmacist
  • Saint Cloud, MN
  • NPI 1043361249
  NPD Authorized official
• Paul Richard Ebert, RPH

  • Pharmacist
  • Elk River, MN
  • NPI 1295057412
  NPD (past)
• Keith R Holme, RPH

  • Pharmacist
  • Elk River, MN
  • NPI 1942527320
  NPD (past)
• Rachel Puffe, PHARMD

  • Pharmacist
  • Elk River, MN
  • NPI 1497103022
  NPD (past)
• Wendy L Simenson, RPH

  • Pharmacist
  • Elk River, MN
  • NPI 1629238274
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513728000000",
    "number": "1013915040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 JACKSON AVE NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "55330",
            "telephone_number": "763-441-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 JACKSON AVE NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "55330",
            "telephone_number": "763-441-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK RIVER PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2017-12-20",
        "status": "A",
        "authorized_official_last_name": "LEEDAHL",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-441-1353",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "261701",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "265251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2043890",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elk River Family Dentistry
• Elk River Fire & Ambulance Service
• Elk River Foot & Ankle Clinic PA
• Elk River Municipal Utilities
• Elk River Operations, LLC
• Robert A Elveru, PT
• Theresa Jane Elyea
• Embrace Mental Wellness
• Encompass Integrative Health, LLC
• Encouraging Results Counseling, P.C.

• Community/Retail Pharmacy in Elk River, MN
• Providers in Elk River, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.