Organization Active NPI

Medical Pharmacy Moorhead Inc

  • Community/Retail Pharmacy
  • Moorhead, MN
National Provider Identifier
1215063409
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
260722 Issued in MN
Legal business name
MEDICAL PHARMACY MOORHEAD INC
Practice address
101 11TH St S
Moorhead, MN 56560-2899
Phone
(218) 233-7365
Fax
(218) 233-5702
NPI assigned
Feb 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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

Authorized official

Name
Sheila Nudell, RPH
Title
President and Manager
Phone
(218) 233-7365

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 260722 MN Primary
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

101 11TH St S
Moorhead, MN 56560-2899

Mailing address

101 11TH St S
Moorhead, MN 56560-2899
Phone (218) 233-7365

Other identifiers 3

IdentifierTypeStateIssuer
021062MedicaidND
2046710OtherPK
066360300MedicaidMN

Other names 1

  • MEDICAL PHARMACY MOORHEAD Doing business as

National Provider Directory

National Provider Directory

Locations

101 11th St S
Moorhead, MN 56560
Phone (218) 233-7365

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1215063409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 11TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602899",
            "telephone_number": "218-233-7365",
            "fax_number": "218-233-5702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 11TH ST S",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602899",
            "telephone_number": "218-233-7365",
            "fax_number": "218-233-5702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PHARMACY MOORHEAD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-24",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "NUDELL",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "PRESIDENT AND MANAGER",
        "authorized_official_telephone_number": "218-233-7365",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "260722",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021062",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2046710",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "066360300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL PHARMACY MOORHEAD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moorhead, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.