Active NPI
Duane Wallace, RPH
- Pharmacist
- Perham, MN
National Provider Identifier
1679730378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 114023
- Practice address
- 665 3Rd St SW
Perham, MN 56573-1137 - Phone
- (218) 346-1169
- Fax
- (218) 346-1279
- NPI assigned
- May 20, 2008
- Last updated
- May 20, 2008
- 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 | 114023 | MN | Primary |
Addresses
Primary practice location
665 3Rd St SW
Perham, MN 56573-1137
Mailing address
665 3Rd St SW
Perham, MN 56573-1137
Phone (218) 346-1169
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114023 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1679730378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "665 3RD ST SW",
"city": "PERHAM",
"state": "MN",
"postal_code": "565731137",
"telephone_number": "218-346-1169",
"fax_number": "218-346-1279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "665 3RD ST SW",
"city": "PERHAM",
"state": "MN",
"postal_code": "565731137",
"telephone_number": "218-346-1169",
"fax_number": "218-346-1279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DUANE",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-20",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "114023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Perham, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.