Alexis Nicole Nyberg, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

124773 Issued in MN

Practice address

1542 Golf Course Rd Ste 205
Grand Rapids, MN 55744-3537

Phone

(218) 322-6210

NPI assigned

Jul 6, 2022

Last updated

Jul 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

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

• The Duluth Clinic LTD

  dba Essentia Health Grand Rapids Pharmacy

  • Community/Retail Pharmacy
  • Grand Rapids, MN
  • NPI 1831690346
  NPD (past)
• The Duluth Clinic, LTD.

  dba Essentia Health Hinckley Pharmacy

  • Community/Retail Pharmacy
  • Hinckley, MN
  • NPI 1245081066
  NPD (past)

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

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658966400000",
    "number": "1588397574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32712 STATE HIGHWAY 6",
            "city": "DEER RIVER",
            "state": "MN",
            "postal_code": "566363002",
            "telephone_number": "605-553-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1542 GOLF COURSE RD STE 205",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443537",
            "telephone_number": "218-322-6210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYBERG",
        "first_name": "ALEXIS",
        "middle_name": "NICOLE",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-06",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SD",
            "license": "6759",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "124773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northwoods Villa Inc.
• Northwoods Villa Inc. (Northwoods Villa Inc. 3)
• Northwoods Villa Inc. 2
• Ryan Thayer Novak, M.D.
• Nathan M Noznesky, M.D.
• Peace Obeta
• Jennifer Oja, PA-C
• Jeffrey Olds, LICSW
• Bobbi Jean Olson, CNP
• Brenna Olson

• Pharmacist in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; 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.