NPIMap

Organization Active NPI

North Memorial Health Care

Doing business as North Memorial Health Pharmacy - Cancer Center

  • Community/Retail Pharmacy
  • Robbinsdale, MN
National Provider Identifier
1093905259
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
263023 Issued in MN
Legal business name
NORTH MEMORIAL HEALTH CARE
Doing business as
North Memorial Health Pharmacy - Cancer Center
Practice address
3435 W Broadway Ave Ste 1150
Robbinsdale, MN 55422-2969
Phone
(763) 520-1152
Fax
(763) 520-1976
NPI assigned
Jul 25, 2007
Last updated
Dec 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Authorized official

Name
Stephanie R Gale
Title
Interim Cfo
Phone
(763) 581-4635

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 263023 MN Primary

Addresses

Primary practice location

3435 W Broadway Ave Ste 1150
Robbinsdale, MN 55422-2969

Mailing address

3435 W Broadway Ave Ste 1150
Robbinsdale, MN 55422-2969
Phone (763) 520-1152

Other names 1

  • North Memorial Health Pharmacy - Cancer Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930042315 MN DME Supplier - PharmacyDME Supplier - Physician - Hematology/Oncology 0042123028 1 other NPI on this enrollment
Practice locations: Robbinsdale, MN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0402364North Memorial Health Cancer Center3435 West Broadway, Robbinsdale, MN 55422AccreditationJul 18, 2028

National Provider Directory

National Provider Directory
Tax ID family
Bass Lake Physicians7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3435 W Broadway Ave
Robbinsdale, MN 55422
Phone (763) 520-7887

3435 W Broadway Ave
Ste 1135
Robbinsdale, MN 55422
Phone (763) 520-7887

3435 W Broadway Ave
Ste 1150
Robbinsdale, MN 55422
Phone (763) 520-1152

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Maple Grove Hospital CorporationMaple Grove, MN, CCN 240214 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 15, 2022
Apr 15, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1093905259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3435 W BROADWAY AVE STE 1150",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222969",
            "telephone_number": "763-520-1152",
            "fax_number": "763-520-1976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3435 W BROADWAY AVE STE 1150",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222969",
            "telephone_number": "763-520-1152",
            "fax_number": "763-520-1976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MEMORIAL HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A",
        "authorized_official_last_name": "GALE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "INTERIM CFO",
        "authorized_official_telephone_number": "763-581-4635"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "263023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Memorial Health Pharmacy - Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Memorial Health Pharmacy - Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Robbinsdale, MN

Sources for this page

Verify at the official NPI Registry.