Active NPI
Lisa Gunderson, PHARMD
- Pharmacist
- East Grand Forks, MN
National Provider Identifier
1639479207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 125524
- Practice address
- 1402 Central Ave NE
East Grand Forks, MN 56721-1605 - Phone
- (218) 773-5610
- NPI assigned
- Oct 28, 2010
- Last updated
- Apr 8, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | S016978 | AZ | |
| Pharmacist | 183500000X | 125524 | MN | Primary |
Addresses
Primary practice location
1402 Central Ave NE
East Grand Forks, MN 56721-1605
Mailing address
1402 Central Ave NE
East Grand Forks, MN 56721-1605
Phone (218) 773-5610
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 |
|---|---|---|---|
| S016978 | AZ | MD | Pharmacist |
| 125524 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1402 Central Ave NE
East Grand Forks, MN 56721
Phone (218) 773-5610
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680912000000",
"number": "1639479207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 CENTRAL AVE NE",
"city": "EAST GRAND FORKS",
"state": "MN",
"postal_code": "567211605",
"telephone_number": "218-773-5610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 CENTRAL AVE NE",
"city": "EAST GRAND FORKS",
"state": "MN",
"postal_code": "567211605",
"telephone_number": "218-773-5610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSON",
"first_name": "LISA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-28",
"last_updated": "2023-04-08",
"certification_date": "2023-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AZ",
"license": "S016978",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "125524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Grand Forks, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.