Active NPI
Tamera Lynn Haase, PHARMD
- Pharmacist
- Plymouth, MN
National Provider Identifier
1386921633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 117733
- Practice address
- 3255 Vicksburg LN N
Plymouth, MN 55447-1317 - Phone
- (763) 253-8917
- NPI assigned
- Nov 14, 2011
- 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 | 117733 | MN | Primary |
Addresses
Primary practice location
3255 Vicksburg LN N
Plymouth, MN 55447-1317
Mailing address
16880 79TH Ave N
Maple Grove, MN 55311-3716
Phone (763) 286-6630
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 |
|---|---|---|---|
| 117733 | 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 and National Provider Directory roles.
-
- Pharmacy
- Plymouth, MN
- NPI 1477568608
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321228800000",
"number": "1386921633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16880 79TH AVE N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553113716",
"telephone_number": "763-286-6630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3255 VICKSBURG LN N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554471317",
"telephone_number": "763-253-8917"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAASE",
"first_name": "TAMERA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-14",
"last_updated": "2011-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "117733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.