Cederstrom Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

260950 Issued in MN

Legal business name

CEDERSTROM PHARMACY INC

Doing business as

Cederstrom Pharmacy

Practice address

1004 1St St S
Willmar, MN 56201-3510

Phone

(320) 235-7803

Fax

(320) 235-7807

NPI assigned

Nov 15, 2006

Last updated

Jun 27, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Steven Cedertrom

Title

Pres

Phone

(320) 235-7803

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• CEDERSTROM PHARMACY Doing business as

Locations

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1578635363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 1ST ST S",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 1ST ST S",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013510",
            "telephone_number": "320-235-7803",
            "fax_number": "320-235-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDERSTROM PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "CEDERTROM",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "320-235-7803"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "260950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "972860100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2418312",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CEDERSTROM PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carris Health LLC (CentraCare Willmar Surgery Center)
• Carris Health, LLC (CentraCare - Dental Clinic)
• Carroll Psychological Services, Inc.
• Patrick J. Carroll, M.A.
• Guadalupe T Castillo, LADC,
• Steve Rodger Cederstrom, RPH
• Brittany Ceesay, LICSW
• Centracare Clinic Southwest LLC
• Centracare Clinic Southwest LLC
• Centracare Medical Supply LLC (Rice Home Medical LLC DME Willmar)

• Community/Retail Pharmacy in Willmar, MN
• Providers in Willmar, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.

Verify at the official NPI Registry.