NPIMap

Individual provider Active NPI

Wilbur Wayne Kalstrom, RPH

  • Pharmacist
  • Sartell, MN
National Provider Identifier
1043589856
Registry record updated Dec 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
110370 Issued in MN
Practice address
1100 2ND St S
Sartell, MN 56377-2152
Phone
(320) 654-8542
Fax
(320) 654-8603
NPI assigned
Dec 22, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 110370 MN Primary

Addresses

Primary practice location

1100 2ND St S
Sartell, MN 56377-2152

Mailing address

316 16TH Ave SE
Saint Cloud, MN 56304-1307
Phone (320) 251-0156

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
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
110370MNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1043589856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 16TH AVE SE",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563041307",
            "telephone_number": "320-251-0156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 2ND ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772152",
            "telephone_number": "320-654-8542",
            "fax_number": "320-654-8603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALSTROM",
        "first_name": "WILBUR",
        "middle_name": "WAYNE",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "110370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.