Samuel Koob, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

124485 Issued in MN

Practice address

2312 Bemidji Ave N
Bemidji, MN 56601-2318

Phone

(218) 751-1626

NPI assigned

Mar 29, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grand St Paul CVS LLC

  • Pharmacy
  • Plymouth, MN
  • NPI 1437620903
  NPD (past)
• Grand St. Paul CVS LLC

  • Pharmacy
  • Bemidji, MN
  • NPI 1679949028
  NPD (past)

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

{
    "created_epoch": "1585440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585440000000",
    "number": "1821626532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 BEMIDJI AVE N",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012318",
            "telephone_number": "218-751-1626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 BEMIDJI AVE N",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012318",
            "telephone_number": "218-751-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOB",
        "first_name": "SAMUEL",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-29",
        "last_updated": "2020-03-29",
        "certification_date": "2020-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SD",
            "license": "6720",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "124485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "pharmacy10756@CVS.com",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2312 Bemidji Ave N",
            "city": "Bemidji",
            "state": "MN",
            "country_code": "US",
            "postal_code": "566012318",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "pharmacy10756@CVS.com",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2312 Bemidji Ave N",
            "city": "Bemidji",
            "state": "MN",
            "country_code": "US",
            "postal_code": "566012318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Heather Lee Knutson, MS, RD, LD
• Ericka Kollin, RDH
• Sean Mitchell Kolodji, D.C.
• John D Kolstoe, MD
• Danielle Norby Kondziolka, LICSW
• Beth Ann Korczak, PA-C
• John Wesley Kosko Jr., MD
• Joseph P Koury, M.D.
• McKayla Ann Kraft, PT, DPT
• Rebekah Kraft, RN

• All providers in Bemidji, MN
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.