Individual provider Active NPI

Angela Panter

  • Pharmacist
  • Brooklyn Center, MN
National Provider Identifier
1538764733
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
114891 Issued in MN
Practice address
3245 County Road 10
Brooklyn Center, MN 55429-3079
Phone
(763) 503-6810
NPI assigned
Dec 3, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 114891 MN Primary

Addresses

Primary practice location

3245 County Road 10
Brooklyn Center, MN 55429-3079

Mailing address

3245 County Road 10
Brooklyn Center, MN 55429-3079

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

LicenseStateTypeSpecialty
114891MNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Supervalu Pharmacies Inc. PastSince Dec 6, 2020 Accepting new patients
Supervalu Pharmacies Inc PastSince Dec 6, 2020 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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1538764733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 COUNTY ROAD 10",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 COUNTY ROAD 10",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293079",
            "telephone_number": "763-503-6810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTER",
        "first_name": "ANGELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "114891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Center, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.