Active NPI
Charles Mickelson
- Pharmacist
- Pipestone, MN
National Provider Identifier
1437740040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 112690
- Practice address
- 802 8TH Ave SE
Pipestone, MN 56164-1734 - Phone
- (507) 825-4259
- NPI assigned
- Jan 27, 2021
- Sex
- Male
- 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 | 112690 | MN | Primary |
Addresses
Primary practice location
802 8TH Ave SE
Pipestone, MN 56164-1734
Mailing address
PO Box 745
Pipestone, MN 56164-0745
Phone (507) 825-4259
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 |
|---|---|---|---|
| 112690 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sanford Medical Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611705600000",
"number": "1437740040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 745",
"city": "PIPESTONE",
"state": "MN",
"postal_code": "561640745",
"telephone_number": "507-825-4259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 8TH AVE SE",
"city": "PIPESTONE",
"state": "MN",
"postal_code": "561641734",
"telephone_number": "507-825-4259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKELSON",
"first_name": "CHARLES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-27",
"last_updated": "2021-01-27",
"certification_date": "2021-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "112690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pipestone, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.