Stacie Marie Gallentine, PHARM D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

118193 Issued in MN

Practice address

9655 Colorado LN N
Brooklyn Park, MN 55445

Phone

(763) 315-0737

NPI assigned

Jun 27, 2007

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 identifiers 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": "1182902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508063249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8809 32ND CT N",
            "city": "NEW HOPE",
            "state": "MN",
            "postal_code": "554272456",
            "telephone_number": "612-396-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9655 COLORADO LN N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "55445",
            "telephone_number": "763-315-0737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLENTINE",
        "first_name": "STACIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PHARM D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "118193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "118193",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.