Active NPI
Derek Bergquist, PHARMD/MBA
- Pharmacist
- Minneapolis, MN
National Provider Identifier
1174922413
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 121398
- Practice address
- 2426 Hennepin Ave
Minneapolis, MN 55405-2604 - Phone
- (651) 377-3308
- Fax
- (612) 377-5670
- NPI assigned
- Aug 21, 2014
- Sex
- Male
- 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 | 121398 | MN | Primary |
Addresses
Primary practice location
2426 Hennepin Ave
Minneapolis, MN 55405-2604
Mailing address
2426 Hennepin Ave
Minneapolis, MN 55405-2604
Phone (651) 377-3308
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
- Master of Business Administration, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121398 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1408579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1408579200000",
"number": "1174922413",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2426 HENNEPIN AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554052604",
"telephone_number": "651-377-3308",
"fax_number": "612-377-5670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2426 HENNEPIN AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554052604",
"telephone_number": "651-377-3308",
"fax_number": "612-377-5670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGQUIST",
"first_name": "DEREK",
"credential": "PHARMD/MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-21",
"last_updated": "2014-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "121398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.