Active NPI
Courtney Ackerman, RPH
- Pharmacist
- Waite Park, MN
National Provider Identifier
1831865971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 125301
- Practice address
- 113 Waite Ave N
Waite Park, MN 56387-1246 - Phone
- (320) 259-1148
- NPI assigned
- Aug 18, 2021
- Last updated
- Aug 18, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH6343 | ND | |
| Pharmacist | 183500000X | 125301 | MN | Primary |
Addresses
Primary practice location
113 Waite Ave N
Waite Park, MN 56387-1246
Mailing address
4621 75TH St NE
Sauk Rapids, MN 56379-9712
Other practice location 1
1106 8th St SW
Pipestone, MN 56164-1078
Phone (507) 825-0091
Other practice location 2
1100 7th Ave S
Princeton, MN 55371-4757
Phone (763) 389-8421
Other practice location 3
645 Lake St S
Long Prairie, MN 56347-1545
Phone (320) 732-2915
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 |
|---|---|---|---|
| 125301 | MN | MD | Pharmacist |
| RPH6343 | ND | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coborns Inc | Past | Accepting new patients | |
| Coborns Inc | Past | Accepting new patients | |
| Coborns Inc | Past | Accepting new patients |
Organizations & group practices 3
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": "1629244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629244800000",
"number": "1831865971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4621 75TH ST NE",
"city": "SAUK RAPIDS",
"state": "MN",
"postal_code": "563799712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 WAITE AVE N",
"city": "WAITE PARK",
"state": "MN",
"postal_code": "563871246",
"telephone_number": "320-259-1148"
}
],
"practiceLocations": [
{
"address_1": "1106 8th St SW",
"address_purpose": "LOCATION",
"city": "Pipestone",
"state": "MN",
"postal_code": "561641078",
"country_code": "US",
"telephone_number": "507-825-0091",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1100 7th Ave S",
"address_purpose": "LOCATION",
"city": "Princeton",
"state": "MN",
"postal_code": "553714757",
"country_code": "US",
"telephone_number": "763-389-8421",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "645 Lake St S",
"address_purpose": "LOCATION",
"city": "Long Prairie",
"state": "MN",
"postal_code": "563471545",
"country_code": "US",
"telephone_number": "320-732-2915",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ACKERMAN",
"first_name": "COURTNEY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-18",
"last_updated": "2021-08-18",
"certification_date": "2021-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ND",
"license": "RPH6343",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "125301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waite Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.