Active NPI
Jill Ann Tetrick, RPH
- Oncology Pharmacist
- Maplewood, MN
National Provider Identifier
1326110602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oncology Pharmacist
- License
- 1145032
- Practice address
- 1580 Beam Ave
Maplewood, MN 55109-1127 - Phone
- (651) 255-8480
- NPI assigned
- Nov 14, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Oncology Pharmacist | 1835X0200X | 1145032 | MN | Primary |
Addresses
Primary practice location
1580 Beam Ave
Maplewood, MN 55109-1127
Mailing address
8345 Fairchild Ave
Mounds View, MN 55112-6122
Phone (763) 785-0574
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1145032 | MN | MD | Oncology Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326110602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8345 FAIRCHILD AVE",
"city": "MOUNDS VIEW",
"state": "MN",
"postal_code": "551126122",
"telephone_number": "763-785-0574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 BEAM AVE",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551091127",
"telephone_number": "651-255-8480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETRICK",
"first_name": "JILL",
"middle_name": "ANN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1835X0200X",
"taxonomy_group": "",
"desc": "Pharmacist, Oncology",
"state": "MN",
"license": "1145032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.