Jacob C Nelson, PHARMD
Individual provider Active NPI Pharmacist · Moose Lake, MN
NPI 1396186151 · NPPES record last updated Jul 9, 2013
Key facts
- NPI
- 1396186151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 120004 (MN)
- Practice address
- 441 Arrowhead LN
Moose Lake, MN 55767-7702 - Phone
- (218) 485-4401
- Fax
- (218) 485-8774
- NPI assigned
- Jul 9, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120004 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrifty Drug Stores Inc | Past | Accepting new patients | |
| Thrifty Drug Stores Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 120004 | MN | Yes |
Addresses
Primary practice location
441 Arrowhead LN
Moose Lake, MN 55767-7702
Mailing address
PO Box 719
Moose Lake, MN 55767-0719
Phone (218) 485-4401
Other providers in Moose Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.