Jacob C Nelson, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

120004 Issued in MN

Practice address

441 Arrowhead LN
Moose Lake, MN 55767-7702

Phone

(218) 485-4401

Fax

(218) 485-8774

NPI assigned

Jul 9, 2013

Last updated

Jul 9, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

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.

• Thrifty Drug Stores Inc

  dba Thrifty White Pharmacy #754

  • Community/Retail Pharmacy
  • Moose Lake, MN
  • NPI 1598855439
  NPD (past)
• Thrifty Drug Stores Inc

  dba Thrifty White Pharmacy #795

  • Community/Retail Pharmacy
  • Wadena, MN
  • NPI 1710678545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1396186151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 719",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557670719",
            "telephone_number": "218-485-4401",
            "fax_number": "218-485-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 ARROWHEAD LN",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557677702",
            "telephone_number": "218-485-4401",
            "fax_number": "218-485-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JACOB",
        "middle_name": "C",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-09",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "120004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moose Lake Community Hospital District (Mercy Hospital & Health Care Center)
• Moose Lake Community Hospital District (Mercy Home Health Agency)
• Moose Lake Community Hospital District (Mercy Hospital)
• Moose Lake Eye Care LLC
• Msocs-Moose Lake
• Maggie Beth Neudecker, MD
• Ronald William Neva, PT
• Scott Nielsen, MA, CPRP
• Glenn H. Nordehn, D.O.
• Northern Lakes Surgery Center LLC (Northern Lake Surgery Center DME)

• Pharmacist in Moose Lake, MN
• Providers in Moose Lake, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.