Active NPI
Lisa Marie Gabrielson
- Pharmacist
- Woodbury, MN
National Provider Identifier
1710440904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 120451
- Practice address
- 9925 Hudson PL
Woodbury, MN 55125-9461 - Phone
- (651) 702-7980
- Fax
- (651) 702-7983
- NPI assigned
- Apr 13, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 120451 | MN | Primary |
Addresses
Primary practice location
9925 Hudson PL
Woodbury, MN 55125-9461
Mailing address
11208 Whitewater Dr
Woodbury, MN 55129-5309
Phone (701) 893-8607
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120451 | Other | MN | MN BOARD OF PHARMACY |
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 |
|---|---|---|---|
| 120451 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555113600000",
"number": "1710440904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11208 WHITEWATER DR",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551295309",
"telephone_number": "701-893-8607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9925 HUDSON PL",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551259461",
"telephone_number": "651-702-7980",
"fax_number": "651-702-7983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GABRIELSON",
"first_name": "LISA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-13",
"last_updated": "2019-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "120451",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BOARD OF PHARMACY",
"identifier": "120451",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.