Active NPI
Kammy Larson
- Pharmacist
- Wadena, MN
National Provider Identifier
1417329582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 122407
- Practice address
- 321 Jefferson St N
Wadena, MN 56482-1372 - Phone
- (218) 631-4050
- Fax
- (218) 631-2726
- NPI assigned
- Oct 28, 2015
- Last updated
- Oct 28, 2015
- Sex
- Female
- Sole proprietor
- No
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 | 122407 | MN | Primary |
Addresses
Primary practice location
321 Jefferson St N
Wadena, MN 56482-1372
Mailing address
321 Jefferson St N
Wadena, MN 56482-1372
Phone (218) 631-4050
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122407 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445990400000",
"number": "1417329582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 JEFFERSON ST N",
"city": "WADENA",
"state": "MN",
"postal_code": "564821372",
"telephone_number": "218-631-4050",
"fax_number": "218-631-2726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 JEFFERSON ST N",
"city": "WADENA",
"state": "MN",
"postal_code": "564821372",
"telephone_number": "218-631-4050",
"fax_number": "218-631-2726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "KAMMY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-28",
"last_updated": "2015-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "122407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wadena, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.