Active NPI
Mengistu S Kifle, PHARM. D.
- Pharmacist
- Andover, MN
National Provider Identifier
1285220616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 121462
- Practice address
- 1851 Bunker Lake Blvd NW
Andover, MN 55304-4010 - Phone
- (763) 354-5720
- NPI assigned
- Dec 20, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 | 121462 | MN | Primary |
Addresses
Primary practice location
1851 Bunker Lake Blvd NW
Andover, MN 55304-4010
Mailing address
1230 Silverwood CT
Woodbury, MN 55125-9151
Phone (612) 817-1198
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 |
|---|---|---|---|
| 121462 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608422400000",
"number": "1285220616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1230 SILVERWOOD CT",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551259151",
"telephone_number": "612-817-1198"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1851 BUNKER LAKE BLVD NW",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553044010",
"telephone_number": "763-354-5720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIFLE",
"first_name": "MENGISTU",
"middle_name": "S",
"credential": "PHARM. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-20",
"last_updated": "2020-12-20",
"certification_date": "2020-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "121462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.