Active NPI
Kaitlin Marie Bourgeois, PHARMD
- Pharmacist
- Saint Paul, MN
National Provider Identifier
1265114607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 126070
- Practice address
- 153 Cesar Chavez St
Saint Paul, MN 55107-2226 - Phone
- (651) 602-7500
- NPI assigned
- Aug 4, 2023
- Last updated
- Jan 16, 2025
- Sex
- Female
- 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 | 126070 | MN | Primary |
Addresses
Primary practice location
153 Cesar Chavez St
Saint Paul, MN 55107-2226
Mailing address
180 County Road B2 E Apt 35
Little Canada, MN 55117-1517
Phone (763) 302-9624
Other practice location 1
2700 Lincoln Dr
Roseville, MN 55113-1333
Phone (651) 636-9369
Other practice location 2
895 7th St E
Saint Paul, MN 55106-3871
Phone (651) 602-7500
Other names 1
- Kaitlin Marie Bredenkamp
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 |
|---|---|---|---|
| 126070 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736985600000",
"number": "1265114607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 COUNTY ROAD B2 E APT 35",
"city": "LITTLE CANADA",
"state": "MN",
"postal_code": "551171517",
"telephone_number": "763-302-9624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "153 CESAR CHAVEZ ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551072226",
"telephone_number": "651-602-7500"
}
],
"practiceLocations": [
{
"address_1": "2700 Lincoln Dr",
"address_purpose": "LOCATION",
"city": "Roseville",
"state": "MN",
"postal_code": "551131333",
"country_code": "US",
"telephone_number": "651-636-9369",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "895 7th St E",
"address_purpose": "LOCATION",
"city": "Saint Paul",
"state": "MN",
"postal_code": "551063871",
"country_code": "US",
"telephone_number": "651-602-7500",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOURGEOIS",
"first_name": "KAITLIN",
"middle_name": "MARIE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-04",
"last_updated": "2025-01-16",
"certification_date": "2025-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "126070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KAITLIN",
"last_name": "BREDENKAMP",
"middle_name": "MARIE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.