Active NPI
Omoaluse Memsoh Amoni, PHARM D
- Pharmacist
- Brooklyn Park, MN
National Provider Identifier
1356937536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 116638
- Practice address
- 7555 W Broadway Ave
Brooklyn Park, MN 55428-1297 - Phone
- (763) 424-0525
- NPI assigned
- Dec 12, 2020
- 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 | 116638 | MN | Primary |
Addresses
Primary practice location
7555 W Broadway Ave
Brooklyn Park, MN 55428-1297
Mailing address
7555 W Broadway Ave
Brooklyn Park, MN 55428-1297
Phone (763) 424-0525
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 |
|---|---|---|---|
| 116638 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supervalu Pharmacies Inc. | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Burnsville, MN
- NPI 1093517914
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607731200000",
"number": "1356937536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7555 W BROADWAY AVE",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554281297",
"telephone_number": "763-424-0525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7555 W BROADWAY AVE",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554281297",
"telephone_number": "763-424-0525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMONI",
"first_name": "OMOALUSE",
"middle_name": "MEMSOH",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-12",
"last_updated": "2020-12-12",
"certification_date": "2020-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "116638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 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.