Active NPI
Susan Anderson, PHARM D
- Pharmacist
- Plymouth, MN
National Provider Identifier
1831581172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 121755
- Practice address
- 4005 Vinewood Lane N
Walgreens 02767
Plymouth, MN 55442 - Phone
- (763) 553-9731
- Fax
- (763) 553-9144
- NPI assigned
- Feb 24, 2015
- Last updated
- Feb 24, 2015
- 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 | 121755 | MN | Primary |
Addresses
Primary practice location
4005 Vinewood Lane N
Walgreens 02767
Plymouth, MN 55442
Mailing address
4005 Vinewood Lane N
Walgreens 02767
Plymouth, MN 55442
Phone (763) 553-9731
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121755 | Other | MN | MN BOARD OF PHARMACY 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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 121755 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
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": "1424736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424736000000",
"number": "1831581172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 VINEWOOD LANE N",
"address_2": "WALGREENS 02767",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "55442",
"telephone_number": "763-553-9731",
"fax_number": "763-553-9144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 VINEWOOD LANE N",
"address_2": "WALGREENS 02767",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "55442",
"telephone_number": "763-553-9731",
"fax_number": "763-553-9144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-24",
"last_updated": "2015-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "121755",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BOARD OF PHARMACY LICENSE NUMBER",
"identifier": "121755",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
- Kyle John Anderson, MD
- Rebecca Anderson, M.D.
- Sandra Mae Anderson, LPCC
- Shauna Anderson, D.D.S.
- Shelly L Anderson, M.D.
- Laura Utz Anderton, NP
- Anjani Sahaay LLC (Home Helpers Home Care of Eden Prairie, MN)
- Anne Byer PHD Licensed Psychologist PLLC
- Anne Silverman Consulting LLC
- Jennifer Lyn Annunziata, OCCUPATIONAL THERAPI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.