Miles Book
Individual provider Active NPI Pharmacist · Chaska, MN
NPI 1205422771 · NPPES record last updated Dec 17, 2020
Key facts
- NPI
- 1205422771
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 123526 (MN)
- Practice address
- 200 Pioneer TRL
Chaska, MN 55318-1169 - Phone
- (952) 368-2849
- NPI assigned
- Dec 17, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 123526 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 123526 | MN | Yes |
Addresses
Primary practice location
200 Pioneer TRL
Chaska, MN 55318-1169
Mailing address
200 Pioneer TRL
Chaska, MN 55318-1169
Other providers in Chaska, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 17, 2020. 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.