Jordan Cole Andrud

Key facts

NPI

1114652500

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

RPH6422 (ND)

Practice address

2522 Broadway N
Fargo, ND 58102-1405

Phone

(701) 235-5543

NPI assigned

Jul 19, 2022

Sex

Male

Sole proprietor

No

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 and National Provider Directory roles.

• Johnson Drug Co Community/Retail Pharmacy · Fargo, ND · NPI 1457419962
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 19, 2022.

{
    "created_epoch": "1658188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1114652500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2522 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021405",
            "telephone_number": "701-235-5543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2522 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021405",
            "telephone_number": "701-235-5543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRUD",
        "first_name": "JORDAN",
        "middle_name": "COLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-19",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ND",
            "license": "RPH6422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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