Active NPI
Joseph Marion Delallo, PHARMD
- Pharmacist
- Eden Prairie, MN
National Provider Identifier
1497902043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 118711
- Practice address
- 9995 W 69TH St
Suite 102
Eden Prairie, MN 55344-3457 - Phone
- (952) 656-5095
- Fax
- (952) 656-5096
- NPI assigned
- Aug 26, 2008
- Last updated
- Aug 26, 2008
- Sex
- Male
- 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 | 118711 | MN | Primary |
Addresses
Primary practice location
9995 W 69TH St
Suite 102
Eden Prairie, MN 55344-3457
Mailing address
9995 W 69TH St
Suite 102
Eden Prairie, MN 55344-3457
Phone (952) 656-5095
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118711 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairiestone Pharmacy LLC | Pharmacist | 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": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219708800000",
"number": "1497902043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9995 W 69TH ST",
"address_2": "SUITE 102",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443457",
"telephone_number": "952-656-5095",
"fax_number": "952-656-5096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9995 W 69TH ST",
"address_2": "SUITE 102",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553443457",
"telephone_number": "952-656-5095",
"fax_number": "952-656-5096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELALLO",
"first_name": "JOSEPH",
"middle_name": "MARION",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-26",
"last_updated": "2008-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "118711",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.