Individual provider Active NPI

Tim Johnson, RPH

  • Pharmacist
  • Aitkin, MN
National Provider Identifier
1750708053
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
113724 Issued in MN
Practice address
190 Southgate Dr
Aitkin, MN 56431-7407
Phone
(218) 927-2466
Fax
(218) 927-2597
NPI assigned
Mar 25, 2014
Last updated
Mar 25, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 113724 MN Primary

Addresses

Primary practice location

190 Southgate Dr
Aitkin, MN 56431-7407

Mailing address

PO Box 348
190 Southgate Dr
Aitkin, MN 56431-0348
Phone (218) 927-2466

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

LicenseStateTypeSpecialty
113724MNMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1750708053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 348",
            "address_2": "190 SOUTHGATE DR",
            "city": "AITKIN",
            "state": "MN",
            "postal_code": "564310348",
            "telephone_number": "218-927-2466",
            "fax_number": "218-927-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 SOUTHGATE DR",
            "city": "AITKIN",
            "state": "MN",
            "postal_code": "564317407",
            "telephone_number": "218-927-2466",
            "fax_number": "218-927-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TIM",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "113724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aitkin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.