Active NPI
Jennifer Joan Bodmer, PHARMD
- Pharmacist
- Eden Prairie, MN
National Provider Identifier
1629348149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5144
- Practice address
- 11334 Stratton Ave
Eden Prairie, MN 55344-4420 - Phone
- (701) 217-0156
- NPI assigned
- Jan 2, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 056664 | NY | |
| Pharmacist | 183500000X | 118942 | MN | |
| Pharmacist | 183500000X | 5144 | ND | Primary |
Addresses
Primary practice location
11334 Stratton Ave
Eden Prairie, MN 55344-4420
Mailing address
11334 Stratton Ave
Eden Prairie, MN 55344-4420
Phone (701) 217-0156
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5144 | ND | MD | Social Worker |
| 118942 | MN | MD | Pharmacist |
| 056664 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1629348149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11334 STRATTON AVE",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553444420",
"telephone_number": "701-217-0156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11334 STRATTON AVE",
"city": "EDEN PRAIRIE",
"state": "MN",
"postal_code": "553444420",
"telephone_number": "701-217-0156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODMER",
"first_name": "JENNIFER",
"middle_name": "JOAN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-02",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "056664",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "118942",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ND",
"license": "5144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eden Prairie, 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.