Active NPI
Tyler Todd Clark
- Pharmacist
- Owatonna, MN
National Provider Identifier
1629685698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 124582
- Practice address
- 1130 W Frontage Rd
Owatonna, MN 55060-5662 - Phone
- (507) 451-3323
- NPI assigned
- Sep 24, 2020
- Sex
- Male
- Sole proprietor
- No
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 | 124582 | MN | Primary |
Addresses
Primary practice location
1130 W Frontage Rd
Owatonna, MN 55060-5662
Mailing address
325 Hoffman Dr Apt 312
Owatonna, MN 55060-3282
Phone (320) 515-1620
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 |
|---|---|---|---|
| 124582 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600905600000",
"number": "1629685698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 HOFFMAN DR APT 312",
"city": "OWATONNA",
"state": "MN",
"postal_code": "550603282",
"telephone_number": "320-515-1620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 W FRONTAGE RD",
"city": "OWATONNA",
"state": "MN",
"postal_code": "550605662",
"telephone_number": "507-451-3323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TYLER",
"middle_name": "TODD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-24",
"last_updated": "2020-09-24",
"certification_date": "2020-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "124582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Owatonna, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.