Nicollet Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

NICOLLET PHARMACY LLC

Practice address

2805 Nicollet Ave
Minneapolis, MN 55408-2329

Phone

(612) 644-8142

NPI assigned

Mar 20, 2022

Organization subpart

No

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

Authorized official

Name

Deeq Yussuf Mohammed, PHARMD/RPHNPI 1639774847

Title

Pharmacist in Charge (Pic)

Phone

(612) 644-8142

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN2 enrollments

Enrollment records 2

Tax ID family

Nicollet Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Nicollet Pharmacy LLC

  • Long Term Care Pharmacy
  • Minneapolis, MN
  • NPI 1083537542
  NPD tax ID

Locations

Practitioners 1

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

• Deeq Mohammed, PHARM D

  • Pharmacist
  • Minneapolis, MN
  • NPI 1639774847
  NPD Authorized official

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

{
    "created_epoch": "1647734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647734400000",
    "number": "1285383190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 NICOLLET AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082329",
            "telephone_number": "612-644-8142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 NICOLLET AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082329",
            "telephone_number": "612-644-8142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLLET PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-20",
        "last_updated": "2022-03-20",
        "certification_date": "2022-03-20",
        "status": "A",
        "authorized_official_last_name": "MOHAMMED",
        "authorized_official_first_name": "DEEQ",
        "authorized_official_middle_name": "YUSSUF",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE (PIC)",
        "authorized_official_telephone_number": "612-644-8142",
        "authorized_official_credential": "PHARMD/RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicollet Avenue Dental, PLLC
• Nicollet Chiropractic Center
• Nicollet Dental
• Nicollet Mall Dental Arts PLLC
• Nicollet Pharmacy LLC
• Nicollet Senior Center Inc
• Nicollet Vision Care Optometrists P.a.
• Nicollet Vision Care Optometrists P.a.
• John J Nicotra, MD
• Yingjiu Nie, M.A.

• Community/Retail Pharmacy in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.