Active NPI
Madicen Fanslau, PHARM. D.
- Pharmacist
- Saint Charles, MN
National Provider Identifier
1104429331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 124289
- Practice address
- 401 W 4TH St
Saint Charles, MN 55972-2127 - Phone
- (507) 932-3160
- Fax
- (507) 932-5911
- NPI assigned
- Nov 19, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 124289 | MN | Primary |
Addresses
Primary practice location
401 W 4TH St
Saint Charles, MN 55972-2127
Mailing address
401 W 4TH St
Saint Charles, MN 55972-2127
Phone (507) 932-3160
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 124289 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605744000000",
"number": "1104429331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 W 4TH ST",
"city": "SAINT CHARLES",
"state": "MN",
"postal_code": "559722127",
"telephone_number": "507-932-3160",
"fax_number": "507-932-5911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 W 4TH ST",
"city": "SAINT CHARLES",
"state": "MN",
"postal_code": "559722127",
"telephone_number": "507-932-3160",
"fax_number": "507-932-5911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANSLAU",
"first_name": "MADICEN",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-19",
"last_updated": "2020-11-19",
"certification_date": "2020-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "124289",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.