Active NPI
Mohamed Shukri
- Pharmacist
- Bloomington, MN
National Provider Identifier
1679286462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 125893
- Practice address
- 8609 Lyndale Ave S Ste 101K
Bloomington, MN 55420-2734 - Phone
- (127) 048-0306
- NPI assigned
- Dec 27, 2022
- Last updated
- Jun 21, 2024
- 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 | 125893 | MN | Primary |
Addresses
Primary practice location
8609 Lyndale Ave S Ste 101K
Bloomington, MN 55420-2734
Mailing address
3045 Bloomington Ave Unit 7249
Minneapolis, MN 55407-4039
Phone (404) 372-4647
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 |
|---|---|---|---|
| 125893 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimedicus LLC | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
8609 Lyndale Ave S
Ste 101K
Bloomington, MN 55420
Phone (612) 704-8030
Organizations & group practices 3
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.
-
- Pharmacy
- Bloomington, MN
- NPI 1083455166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718928000000",
"number": "1679286462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3045 BLOOMINGTON AVE UNIT 7249",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554074039",
"telephone_number": "404-372-4647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8609 LYNDALE AVE S STE 101K",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554202734",
"telephone_number": "127-048-0306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUKRI",
"first_name": "MOHAMED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-12-27",
"last_updated": "2024-06-21",
"certification_date": "2024-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "125893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.