Cactus Jack Aanenson

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

4187 Issued in WY

Practice address

113 Comanche Rd
Fort Meade, SD 57741-1002

Phone

(605) 347-2511

NPI assigned

Mar 21, 2023

Last updated

Mar 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1679356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1851093983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 N MAIN ST",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577831427",
            "telephone_number": "307-760-3484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 COMANCHE RD",
            "city": "FORT MEADE",
            "state": "SD",
            "postal_code": "577411002",
            "telephone_number": "605-347-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AANENSON",
        "first_name": "CACTUS",
        "middle_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-21",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "WY",
            "license": "4187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arslan Ahmed, DO
• April Aldrich, RN
• Avery Aldridge, PHARMD.
• Jessica Carolina Allbee, LPN
• Katelyn Allison, RN

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Fort Meade, SD
• Providers in Fort Meade, SD by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; 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.