Active NPI
Crosby Nils Tindal, PHARMD
- Pharmacist
- St Louis Park, MN
National Provider Identifier
1205216033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 123904
- Practice address
- 3620 Texas Ave S
St Louis Park, MN 55426 - Phone
- (952) 933-3177
- Fax
- (952) 933-4187
- NPI assigned
- Jun 7, 2015
- 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 | 123904 | MN | Primary |
Addresses
Primary practice location
3620 Texas Ave S
St Louis Park, MN 55426
Mailing address
3620 Texas Ave S
St Louis Park, MN 55426-4057
Phone (952) 933-3177
Other practice location 1
4840 Sundance Loop Apt B
Hermantown, MN 55811-4085
Phone (952) 457-4160
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 811556 | Other | MN | MINNESOTA BOARD OF PHARMACY INTERN LICENSE NUMBER |
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 |
|---|---|---|---|
| 123904 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supervalu Pharmacies Inc | Past | Accepting new patients | |
| Supervalu Pharmacies 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.
-
- Community/Retail Pharmacy
- St Louis Park, MN
- NPI 1740395888
-
- Community/Retail Pharmacy
- Burnsville, MN
- NPI 1093517914
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531958400000",
"number": "1205216033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3620 TEXAS AVE S",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554264057",
"telephone_number": "952-933-3177",
"fax_number": "952-933-4187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3620 TEXAS AVE S",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "55426",
"telephone_number": "952-933-3177",
"fax_number": "952-933-4187"
}
],
"practiceLocations": [
{
"address_1": "4840 Sundance Loop Apt B",
"address_purpose": "LOCATION",
"city": "Hermantown",
"state": "MN",
"postal_code": "558114085",
"country_code": "US",
"telephone_number": "952-457-4160",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TINDAL",
"first_name": "CROSBY",
"middle_name": "NILS",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-07",
"last_updated": "2018-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "123904",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MINNESOTA BOARD OF PHARMACY INTERN LICENSE NUMBER",
"identifier": "811556",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.