Edwin Ma Thao

Primary specialty

PharmacistTaxonomy code 183500000X

License

125332 Issued in MN

Practice address

11850 Blackfoot St NW Ste 190
Coon Rapids, MN 55433-2583

Phone

(763) 236-7111

NPI assigned

Oct 23, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Longs Drug Store California LLC

  • Pharmacy
  • Kapolei, HI
  • NPI 1700565793
  NPD (past)
• Longs Drug Stores California, LLC

  • Pharmacy
  • Merced, CA
  • NPI 1780876847
  NPD (past)

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1871069310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18212 79TH PL N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553111911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11850 BLACKFOOT ST NW STE 190",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332583",
            "telephone_number": "763-236-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAO",
        "first_name": "EDWIN",
        "middle_name": "MA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-23",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "125332",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "79678",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "edwin.thao@allina.com",
            "affiliation": "N",
            "address_1": "11850 Blackfoot St NW Ste 190",
            "city": "Coon Rapids",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554332583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brittani Lynn Terwilliger, MS
• Ruth Ellen Tessmer
• Erin Withers Thackeray, MD
• Andrew Thao
• Ching Yeng Thao
• Samantha Thayer, OTR/L
• The Fountains Living LLC
• The Homestead at Coon Rapids, Inc.
• The Homestead at Coon Rapids, Inc.
• The Menage

• All providers in Coon Rapids, MN
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.