Active NPI
Kellie Jo Milich, PHARM D
- Pharmacist
- Minneapolis, MN
National Provider Identifier
1780865501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 118954
- Practice address
- Maskiki Waakaaigan
1433 E. Franklin Avenue Suite 11 & 13B
Minneapolis, MN 55404 - Phone
- (612) 874-9128
- Fax
- (612) 874-9128
- NPI assigned
- Nov 20, 2007
- 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 | 118954 | MN | Primary |
Addresses
Primary practice location
Maskiki Waakaaigan
1433 E. Franklin Avenue Suite 11 & 13B
Minneapolis, MN 55404
Mailing address
Fond Du Lac Human Services Division
927 Trettel Lane
Cloquet, MN 55720
Phone (218) 879-1227
Other names 1
- Kellie Jo Varichak
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
| License | State | Type | Specialty |
|---|---|---|---|
| 118954 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410998400000",
"number": "1780865501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "FOND DU LAC HUMAN SERVICES DIVISION",
"address_2": "927 TRETTEL LANE",
"city": "CLOQUET",
"state": "MN",
"postal_code": "55720",
"telephone_number": "218-879-1227",
"fax_number": "218-878-2188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MASKIKI WAAKAAIGAN",
"address_2": "1433 E. FRANKLIN AVENUE SUITE 11 & 13B",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55404",
"telephone_number": "612-874-9128",
"fax_number": "612-874-9128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILICH",
"first_name": "KELLIE",
"middle_name": "JO",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-20",
"last_updated": "2014-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "118954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLIE",
"last_name": "VARICHAK",
"middle_name": "JO",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.