Freeman Maral Mjolsness, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

117652 Issued in MN

Practice address

17435 County Road 6
Plymouth, MN 55447-3046

Phone

(612) 419-0823

NPI assigned

Jan 4, 2021

Sex

Male

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

Credentials

Registered Pharmacist

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)

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1295323582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15710 15TH PL N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554472405",
            "telephone_number": "612-419-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17435 COUNTY ROAD 6",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554473046",
            "telephone_number": "612-419-0823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MJOLSNESS",
        "first_name": "FREEMAN",
        "middle_name": "MARAL",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "117652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mancel Talcott Mitchell III, M.D.
• Mittal Dermatology PA
• Amit Mittal, MD
• Diliana Stoimenova Mittelsteadt, MD
• Pathamas Chantaracherd Mittman, DDS, MS
• MK Labs LLC
• Gabriel Paul Mlodzik, CNP
• Amy Louise Moe, PA
• Kari A Moe, BCBA
• Brooke Renee Moeller

• Pharmacist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; 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.