NPIMap

Individual provider Active NPI

Jenna M Wahlstrom, PHARMD

  • Pharmacist
  • Watford City, ND
National Provider Identifier
1144668104
Registry record updated Jun 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
RPH5577 Issued in ND
Practice address
244 N Main St
Watford City, ND 58854-7124
Phone
(701) 444-2410
Fax
(701) 444-2921
NPI assigned
Jun 11, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH5577 ND Primary

Addresses

Primary practice location

244 N Main St
Watford City, ND 58854-7124

Mailing address

244 N Main St
PO Box 550
Watford City, ND 58854-7124
Phone (701) 444-2410

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

LicenseStateTypeSpecialty
RPH5577NDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Larsen Service Drug Inc Past Accepting new patients
Larsen Service Drug, Inc. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370908800000",
    "number": "1144668104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 N MAIN ST",
            "address_2": "PO BOX 550",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547124",
            "telephone_number": "701-444-2410",
            "fax_number": "701-444-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 N MAIN ST",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547124",
            "telephone_number": "701-444-2410",
            "fax_number": "701-444-2921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHLSTROM",
        "first_name": "JENNA",
        "middle_name": "M",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "ND",
            "license": "RPH5577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watford City, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.