Active NPI
Kelli J Danielson, PHARMD
- Pharmacist
- Brooklyn Center, MN
National Provider Identifier
1891393278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 121509
- Practice address
- 1200 Shingle Creek Xing
Brooklyn Center, MN 55430-2835 - Phone
- (763) 354-1948
- Fax
- (763) 354-1942
- NPI assigned
- Oct 16, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 121509 | MN | Primary |
Addresses
Primary practice location
1200 Shingle Creek Xing
Brooklyn Center, MN 55430-2835
Mailing address
3768 124TH LN NW
Coon Rapids, MN 55433-1637
Phone (920) 606-4783
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 |
|---|---|---|---|
| 121509 | MN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602806400000",
"number": "1891393278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3768 124TH LN NW",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554331637",
"telephone_number": "920-606-4783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 SHINGLE CREEK XING",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302835",
"telephone_number": "763-354-1948",
"fax_number": "763-354-1942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIELSON",
"first_name": "KELLI",
"middle_name": "J",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-16",
"last_updated": "2020-10-16",
"certification_date": "2020-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "121509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.