Active NPI
Jennifer L Peterson, PHARMD
- Pharmacist
- Minneapolis, MN
National Provider Identifier
1417106568
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(3) exclusion effective Jan 18, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 118721
- Practice address
- 410 Church St SE
Boynton Pharmacy
Minneapolis, MN 55455-0222 - Phone
- (612) 624-7655
- NPI assigned
- Sep 13, 2008
- 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 | 118721 | MN | Primary |
Addresses
Primary practice location
410 Church St SE
Boynton Pharmacy
Minneapolis, MN 55455-0222
Mailing address
410 Church St SE
Boynton Pharmacy
Minneapolis, MN 55455-0222
Phone (612) 624-7655
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118721 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221264000000",
"number": "1417106568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 CHURCH ST SE",
"address_2": "BOYNTON PHARMACY",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550222",
"telephone_number": "612-624-7655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 CHURCH ST SE",
"address_2": "BOYNTON PHARMACY",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550222",
"telephone_number": "612-624-7655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JENNIFER",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-13",
"last_updated": "2008-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "118721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.