Individual provider Active NPI

Fahma Abdirahman, PHARMD

  • Community/Retail Pharmacy
  • Mankato, MN
National Provider Identifier
1760078406
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
123496 Issued in MN
Practice address
1270 Madison Ave
Mankato, MN 56001-5228
Phone
(507) 388-1315
NPI assigned
Dec 16, 2020
Last updated
Dec 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 123496 MN Primary

Addresses

Primary practice location

1270 Madison Ave
Mankato, MN 56001-5228

Mailing address

1270 Madison Ave
Mankato, MN 56001-5228
Phone (507) 388-1315

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

LicenseStateTypeSpecialty
123496MNMDCommunity/Retail Pharmacy

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Community/Retail Pharmacy PastSince Dec 22, 2020 Accepting new patients
Walgreen Co Community/Retail Pharmacy PastSince Dec 22, 2020 Accepting new patients

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": "1608076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1760078406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 MADISON AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015228",
            "telephone_number": "507-388-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 MADISON AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560015228",
            "telephone_number": "507-388-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDIRAHMAN",
        "first_name": "FAHMA",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-16",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "123496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.