Active NPI
Nebyeleul Zegeye Reta I, PHARMD
- Pharmacist
- Oakdale, MN
National Provider Identifier
1407128465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 120683
- Practice address
- 7900 32ND St N
Oakdale, MN 55128-4054 - Phone
- (651) 855-0991
- NPI assigned
- Feb 6, 2012
- Sex
- Male
- 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 | 120683 | MN | Primary |
Addresses
Primary practice location
7900 32ND St N
Oakdale, MN 55128-4054
Mailing address
1479 Timberlake Rd
Unit D
Saint Paul, MN 55117-3895
Phone (651) 497-1861
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 |
|---|---|---|---|
| 120683 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand St Paul CVS LLC | Past | Accepting new patients | |
| Grand St Paul CVS LLC | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328486400000",
"number": "1407128465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1479 TIMBERLAKE RD",
"address_2": "UNIT D",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551173895",
"telephone_number": "651-497-1861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7900 32ND ST N",
"city": "OAKDALE",
"state": "MN",
"postal_code": "551284054",
"telephone_number": "651-855-0991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RETA",
"first_name": "NEBYELEUL",
"middle_name": "ZEGEYE",
"name_prefix": "Mr.",
"name_suffix": "I",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-06",
"last_updated": "2012-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "120683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakdale, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.