Active NPI
Brenda Marie Pederson, RPH
- Geriatric Pharmacist
- Lonsdale, MN
National Provider Identifier
1801118955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Pharmacist
- License
- 114314
- Practice address
- 6616 Union Lake TRL
Lonsdale, MN 55046-4324 - Phone
- (507) 744-2958
- Fax
- (507) 744-5894
- NPI assigned
- Feb 17, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Geriatric Pharmacist | 1835G0303X | 114314 | MN | Primary |
Addresses
Primary practice location
6616 Union Lake TRL
Lonsdale, MN 55046-4324
Mailing address
6616 Union Lake TRL
Lonsdale, MN 55046-4324
Phone (507) 744-2958
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114314 | Other | MN | PHARMACIST LICENSE NUMBER |
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 |
|---|---|---|---|
| 114314 | MN | MD | Geriatric Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266364800000",
"number": "1801118955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6616 UNION LAKE TRL",
"city": "LONSDALE",
"state": "MN",
"postal_code": "550464324",
"telephone_number": "507-744-2958",
"fax_number": "507-744-5894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6616 UNION LAKE TRL",
"city": "LONSDALE",
"state": "MN",
"postal_code": "550464324",
"telephone_number": "507-744-2958",
"fax_number": "507-744-5894"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDERSON",
"first_name": "BRENDA",
"middle_name": "MARIE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-17",
"last_updated": "2010-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "1835G0303X",
"taxonomy_group": "",
"desc": "Pharmacist, Geriatric",
"state": "MN",
"license": "114314",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE NUMBER",
"identifier": "114314",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lonsdale, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.