Active NPI
Amelia Lane
- Pharmacy Technician
- White Bear Lake, MN
National Provider Identifier
1114102985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 743079
- Practice address
- 915 Wildwood Rd
White Bear Lake, MN 55115-1847 - Phone
- (651) 426-7333
- NPI assigned
- Dec 29, 2007
- Last updated
- Mar 25, 2022
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 743079 | MN | Primary |
Addresses
Primary practice location
915 Wildwood Rd
White Bear Lake, MN 55115-1847
Mailing address
814 Hennepin Ave Apt 306
Minneapolis, MN 55403-1837
Phone (651) 354-4234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30169368 | Other | PTCB |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 743079 | MN | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Carolina CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648166400000",
"number": "1114102985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "814 HENNEPIN AVE APT 306",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554031837",
"telephone_number": "651-354-4234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 WILDWOOD RD",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551151847",
"telephone_number": "651-426-7333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "AMELIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-29",
"last_updated": "2022-03-25",
"certification_date": "2022-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "MN",
"license": "743079",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTCB",
"identifier": "30169368",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in White Bear Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.