Pamela Renee Tennyson, PHARM D

Key facts

NPI

1265718910

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

117344 (MN)

Practice address

421 Paul Bunyan Dr NW
Bemidji, MN 56601-2435

Phone

(218) 333-4032

Fax

(218) 333-4035

NPI assigned

Oct 26, 2011

Sex

Female

Sole proprietor

No

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.

• Walgreen Co Pharmacy · Bemidji, MN · NPI 1740295971
  NPD (past)
• Walgreen Co Pharmacy · Longview, TX · NPI 1629956545
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 26, 2011.

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319587200000",
    "number": "1265718910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 PAUL BUNYAN DR NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012435",
            "telephone_number": "218-333-4032",
            "fax_number": "218-333-4035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 PAUL BUNYAN DR NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012435",
            "telephone_number": "218-333-4032",
            "fax_number": "218-333-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENNYSON",
        "first_name": "PAMELA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-26",
        "last_updated": "2011-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "117344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Bemidji, MN · Pharmacist in Minnesota