Active NPI
Vincent Osayanmon Adanene
- Pharmacist
- Crystal, MN
National Provider Identifier
1306607957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 114441
- Practice address
- 6800 Bass Lake Rd
Crystal, MN 55428-3935 - Phone
- (763) 533-5804
- Fax
- (763) 537-1841
- NPI assigned
- Jan 22, 2024
- Last updated
- Jan 22, 2024
- Sex
- Male
- Sole proprietor
- No
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 | 114441 | MN | Primary |
Addresses
Primary practice location
6800 Bass Lake Rd
Crystal, MN 55428-3935
Mailing address
6800 Bass Lake Rd
Crystal, MN 55428-3935
Phone (763) 533-5804
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114441 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705881600000",
"number": "1306607957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6800 BASS LAKE RD",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554283935",
"telephone_number": "763-533-5804",
"fax_number": "763-537-1841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6800 BASS LAKE RD",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554283935",
"telephone_number": "763-533-5804",
"fax_number": "763-537-1841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADANENE",
"first_name": "VINCENT",
"middle_name": "OSAYANMON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-22",
"last_updated": "2024-01-22",
"certification_date": "2024-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "114441",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.