Nicole Larson

Primary specialty

PharmacistTaxonomy code 183500000X

License

120545 Issued in MN

Practice address

21455 John Milless Dr
Rogers, MN 55374-9431

Phone

(763) 428-2629

NPI assigned

May 18, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Grand St Paul CVS LLC

  • Pharmacy
  • Plymouth, MN
  • NPI 1437620903
  NPD (past)
• Grand St Paul CVS LLC

  • Pharmacy
  • Rogers, MN
  • NPI 1558566166
  NPD (past)

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1215550868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21455 JOHN MILLESS DR",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21455 JOHN MILLESS DR",
            "city": "ROGERS",
            "state": "MN",
            "postal_code": "553749431",
            "telephone_number": "763-428-2629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-18",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "120545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heath Anthony Langston, CNP
• Ryleigh Laplante
• Victoria Elaine Larkin, OTR
• Larry M Schanus PA
• Andrew W. Larson, M.D.
• Wade M. Larson, M.D.
• Han Ngoc Ly Le
• Lee Prohofsky DDS PA
• Alaina Lee
• Paige Lehto, MS, LMFT

• All providers in Rogers, MN
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; 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.