Kalley Anne Fake, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

125353 Issued in MN

Practice address

1315 Highway 25 N
Buffalo, MN 55313-1937

Phone

(763) 682-2963

NPI assigned

Aug 19, 2021

Last updated

Mar 30, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kalley Anne Pederson Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1417623307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 HIGHWAY 25 N",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131937",
            "telephone_number": "763-682-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAKE",
        "first_name": "KALLEY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-19",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "125353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "k0p06oo.s01577@us.wal-mart.com",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "1315 Highway 25 N",
            "city": "Buffalo",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553131937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KALLEY",
            "last_name": "PEDERSON",
            "middle_name": "ANNE",
            "credential": "PHARMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Pharmacist in Buffalo, MN
• Providers in Buffalo, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.