Susan Ann Hedemark
Individual provider Active NPI Pharmacist · Moorhead, MN
NPI 1194002188 · NPPES record last updated Nov 4, 2011
Key facts
- NPI
- 1194002188
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 114657 (MN)
- Practice address
- 700 30TH Ave S
Moorhead, MN 56560-4926 - Phone
- (218) 331-2668
- NPI assigned
- Nov 4, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114657 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past |
Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 114657 | MN | Yes |
Addresses
Primary practice location
700 30TH Ave S
Moorhead, MN 56560-4926
Mailing address
700 30TH Ave S
Moorhead, MN 56560-4926
Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 4, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.