Clint M Dworshak, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

117076-4 Issued in MN

Practice address

5534 Lakeland Ave N
Crystal, MN 55429-3121

Phone

(763) 259-0188

Fax

(888) 636-9971

NPI assigned

May 21, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238371200000",
    "number": "1053520916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16908 SADDLEWOOD TRL",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553452672",
            "telephone_number": "952-935-9227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5534 LAKELAND AVE N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554293121",
            "telephone_number": "763-259-0188",
            "fax_number": "888-636-9971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWORSHAK",
        "first_name": "CLINT",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-21",
        "last_updated": "2009-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "117076-4",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ND",
            "license": "4803",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN PHARMACIST LICENSE",
            "identifier": "117076-4",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ND PHARMACIST LICENSE",
            "identifier": "4803",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Crystal, MN
• Providers in Crystal, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; 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.