Active NPI
Tanner David Roberts, PHARMD
- Pharmacist
- Staples, MN
National Provider Identifier
1356988281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 124510
- Practice address
- 421 2ND Ave NE
Staples, MN 56479-2539 - Phone
- (218) 894-2242
- Fax
- (218) 894-2013
- NPI assigned
- Dec 10, 2019
- Last updated
- Dec 10, 2019
- 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 | 124510 | MN | Primary |
Addresses
Primary practice location
421 2ND Ave NE
Staples, MN 56479-2539
Mailing address
3200 Southdale Cir Apt 526
Edina, MN 55435-5184
Phone (218) 296-1839
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 |
|---|---|---|---|
| 124510 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longbella Drug Inc | Past | Accepting new patients | |
| Longbella Drug Inc | 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.
-
- Long Term Care Pharmacy
- Staples, MN
- NPI 1750322186
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575936000000",
"number": "1356988281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 SOUTHDALE CIR APT 526",
"city": "EDINA",
"state": "MN",
"postal_code": "554355184",
"telephone_number": "218-296-1839"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421 2ND AVE NE",
"city": "STAPLES",
"state": "MN",
"postal_code": "564792539",
"telephone_number": "218-894-2242",
"fax_number": "218-894-2013"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "TANNER",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-10",
"last_updated": "2019-12-10",
"certification_date": "2019-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "124510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staples, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.