Jan E. Pederson, PHARM.D.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

116988 Issued in MN

Practice address

215 Pennington Ave
Pharmacy
Thief River Falls, MN 56701-2900

Phone

(218) 681-1515

NPI assigned

Mar 21, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

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.

• Valley Markets Inc

  • Community/Retail Pharmacy
  • Thief River Falls, MN
  • NPI 1477626786
  NPD (past)
• Valley Markets, Incorporated

  • Community/Retail Pharmacy
  • Fosston, MN
  • NPI 1023720901
  NPD (past)

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1295851228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21096 GOLD COAST RD NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566019180",
            "telephone_number": "218-686-5562",
            "fax_number": "218-681-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 PENNINGTON AVE",
            "address_2": "PHARMACY",
            "city": "THIEF RIVER FALLS",
            "state": "MN",
            "postal_code": "567012900",
            "telephone_number": "218-681-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "JAN",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "MN",
            "license": "116988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "743688200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oakland Park Communities, Inc
• Justin Alan Olson
• Kathryn Victoria Olson, PHARMD
• Daniel L Paeth, MD
• Sanjay G Patel, MD
• Pediatric Therapy Partners, Inc.
• Paula Lynn Pengilly, FNP
• Pennington & Red Lake County Public Health & Home Care
• Pennington County Human Services
• Pennington Health Services

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Thief River Falls, MN
• Providers in Thief River Falls, MN by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 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.

Verify at the official NPI Registry.