Kevin Alfred Dockendorf, RPH
Individual provider Active NPI Pharmacist · Cold Spring, MN
NPI 1083053276 · NPPES record last updated Jun 20, 2013
Key facts
- NPI
- 1083053276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 116026 (MN)
- Practice address
- 400 Main St
Cold Spring, MN 56320-2324 - Phone
- (320) 685-7015
- Fax
- (320) 685-7025
- NPI assigned
- Jun 20, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116026 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 116026 | MN | Yes |
Addresses
Primary practice location
400 Main St
Cold Spring, MN 56320-2324
Mailing address
400 Main St
Cold Spring, MN 56320-2324
Phone (320) 685-7015
Other providers in Cold Spring, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.