Active NPI
Neil Skupa
- Pharmacist
- Woodbury, MN
National Provider Identifier
1588324917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 122683
- Practice address
- 7070 Tamarack Rd
Woodbury, MN 55125-1205 - Phone
- (612) 540-5458
- NPI assigned
- Dec 27, 2021
- 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 | 122683 | MN | Primary |
Addresses
Primary practice location
7070 Tamarack Rd
Woodbury, MN 55125-1205
Mailing address
2455 County Road E E
White Bear Lake, MN 55110-4805
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
| License | State | Type | Specialty |
|---|---|---|---|
| 122683 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1640563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640563200000",
"number": "1588324917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2455 COUNTY ROAD E E",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551104805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7070 TAMARACK RD",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551251205",
"telephone_number": "612-540-5458"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SKUPA",
"first_name": "NEIL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-12-27",
"last_updated": "2021-12-27",
"certification_date": "2021-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "122683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.