Active NPI
Brenda Lynn Habedank, RPH
- Pharmacist
- Willmar, MN
National Provider Identifier
1487891131
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 115920
- Practice address
- 2201 1St St S
Willmar, MN 56201-4209 - Phone
- (320) 214-8502
- Fax
- (320) 214-8560
- NPI assigned
- Jan 17, 2009
- Last updated
- Jan 17, 2009
- 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 | 115920 | MN | Primary |
Addresses
Primary practice location
2201 1St St S
Willmar, MN 56201-4209
Mailing address
2201 1St St S
Willmar, MN 56201-4209
Phone (320) 214-8502
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115920 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supervalu Pharmacies Inc. | Past | Accepting new patients | |
| Supervalu Pharmacies Inc | 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, 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": "1232150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232150400000",
"number": "1487891131",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 1ST ST S",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562014209",
"telephone_number": "320-214-8502",
"fax_number": "320-214-8560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 1ST ST S",
"city": "WILLMAR",
"state": "MN",
"postal_code": "562014209",
"telephone_number": "320-214-8502",
"fax_number": "320-214-8560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HABEDANK",
"first_name": "BRENDA",
"middle_name": "LYNN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-17",
"last_updated": "2009-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "115920",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willmar, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.