Ryan A Pederson, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

119400 Issued in MN

Practice address

4027 County Road 25
Suite P
Saint Louis Park, MN 55416

Phone

(612) 360-2132

NPI assigned

Jul 31, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • St Louis Park, MN
  • NPI 1629582374
  NPD
• Genoa Healthcare LLC

  • Long Term Care Pharmacy
  • Brockton, MA
  • NPI 1992521512
  NPD (past)

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1538713235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4027 COUNTY ROAD 25",
            "address_2": "SUITE P",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "612-360-2132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4027 COUNTY ROAD 25",
            "address_2": "SUITE P",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "55416",
            "telephone_number": "612-360-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "RYAN",
        "middle_name": "A",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "119400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PDG, P.a. (Park Dental)
• Adina L Peck, DNP, RN, CNP
• Stacie Peckels, MA
• Kerry Pedersen, PA
• David Warren Pederson, DPM
• Pediatric Services PA
• Sue Ellen Peffer, PT
• Peggy Beattie Ma LPCC
• Melody Ann Pekarek, L.AC.
• Sarah Pelinka, MSN, NNP-BC

• Pharmacist in St Louis Park, MN
• Providers in St Louis 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 31, 2019; 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.