Active NPI
Taryn Teresa Ishaug, PHARM D.
- Pharmacist
- St Louis Park, MN
National Provider Identifier
1356627830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 119224
- Practice address
- 1155 Ford Rd
St Louis Park, MN 55426-1099 - Phone
- (612) 284-2197
- Fax
- (612) 808-6759
- NPI assigned
- Oct 27, 2011
- Last updated
- Jan 26, 2021
- Sex
- Female
- 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 | 119224 | MN | Primary |
Addresses
Primary practice location
1155 Ford Rd
St Louis Park, MN 55426-1099
Mailing address
17934 Liv LN
Eden Prairie, MN 55346-4102
Phone (701) 306-4887
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119224 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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": "1319673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611619200000",
"number": "1356627830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17934 LIV LN",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553464102",
"telephone_number": "701-306-4887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 FORD RD",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554261099",
"telephone_number": "612-284-2197",
"fax_number": "612-808-6759"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISHAUG",
"first_name": "TARYN",
"middle_name": "TERESA",
"name_prefix": "Ms.",
"credential": "PHARM D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-27",
"last_updated": "2021-01-26",
"certification_date": "2021-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "119224",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.