Active NPI
James Polucha, PHARM.D
- Pharmacist
- White Bear Lake, MN
National Provider Identifier
1639478845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 116579
- Practice address
- 2187 Fourth Street
White Bear Lake, MN 55110 - Phone
- (651) 429-5356
- Fax
- (651) 429-0425
- NPI assigned
- Mar 28, 2011
- Last updated
- Mar 31, 2011
- 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 | 116579 | MN | Primary |
Addresses
Primary practice location
2187 Fourth Street
White Bear Lake, MN 55110
Mailing address
2187 Fourth Street
White Bear Lake, MN 55110
Phone (651) 429-5356
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 |
|---|---|---|---|
| 116579 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medicine Chest Pharmacy, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Medicine Chest Pharmacy
- Community/Retail Pharmacy
- White Bear Lake, MN
- NPI 1861532376
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301529600000",
"number": "1639478845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2187 FOURTH STREET",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "55110",
"telephone_number": "651-429-5356",
"fax_number": "651-429-0425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2187 FOURTH STREET",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "55110",
"telephone_number": "651-429-5356",
"fax_number": "651-429-0425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLUCHA",
"first_name": "JAMES",
"credential": "PHARM.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-28",
"last_updated": "2011-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "116579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Bear Lake, MN
- PHS-White Bear Lake LLC (Harbor Crossing)
- Paige Pinnow
- Javier Pinon Jr.
- Paolo Emil Puno-Mandapat Pinto
- Brittney Ann Pohto
- Brittani Amber Marie Porter, LPCC, LADC
- Post Acute Pharmacy Consulting
- Zachary Vincent Post, DC
- Premise Health of Minnesota Medical PC (Pipe Trades Services MN Family Health & Wellness Centers)
- Ernest Joseph Price, STUDENT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.