Active NPI
Anastasiya Shtulman, PHARM. D.
- Pharmacist
- Maple Grove, MN
National Provider Identifier
1114200144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 120148
- Practice address
- 11330 Fountains Dr
Maple Grove, MN 55369-7200 - Phone
- (763) 494-8059
- Fax
- (763) 494-8056
- NPI assigned
- Sep 26, 2011
- Last updated
- Aug 15, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 120148 | MN | |
| Pharmacist | 183500000X | 120148 | MN | Primary |
Addresses
Primary practice location
11330 Fountains Dr
Maple Grove, MN 55369-7200
Mailing address
11330 Fountains Dr
Maple Grove, MN 55369-7200
Phone (763) 494-8059
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 |
|---|---|---|---|
| 120148 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660521600000",
"number": "1114200144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11330 FOUNTAINS DR",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553697200",
"telephone_number": "763-494-8059",
"fax_number": "763-494-8056"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11330 FOUNTAINS DR",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553697200",
"telephone_number": "763-494-8059",
"fax_number": "763-494-8056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHTULMAN",
"first_name": "ANASTASIYA",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-26",
"last_updated": "2022-08-15",
"certification_date": "2022-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MN",
"license": "120148",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "120148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 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.