Active NPI
Mark Douglas Nelson, R. PH.
- Pharmacist
- Wyoming, MN
National Provider Identifier
1346304219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 112843-1
- Practice address
- 5200 Fairview Blvd
Pharmacy
Wyoming, MN 55092-8013 - Phone
- (651) 982-7237
- Fax
- (651) 982-7236
- NPI assigned
- Dec 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 112843-1 | MN | Primary |
Addresses
Primary practice location
5200 Fairview Blvd
Pharmacy
Wyoming, MN 55092-8013
Mailing address
670 Mindy CRK
Saint Croix Falls, WI 54024-9413
Phone (715) 483-3152
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 |
|---|---|---|---|
| 112843-1 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346304219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MINDY CRK",
"city": "SAINT CROIX FALLS",
"state": "WI",
"postal_code": "540249413",
"telephone_number": "715-483-3152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5200 FAIRVIEW BLVD",
"address_2": "PHARMACY",
"city": "WYOMING",
"state": "MN",
"postal_code": "550928013",
"telephone_number": "651-982-7237",
"fax_number": "651-982-7236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"credential": "R. PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "112843-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyoming, 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.