Active NPI
Nicholas Allen Van Peursem, PHARMD
- Pharmacist
- Mankato, MN
National Provider Identifier
1902432727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 124484
- Practice address
- 1610 Monks Ave
Mankato, MN 56001-5173 - Phone
- (507) 625-1553
- NPI assigned
- Mar 13, 2020
- Last updated
- Mar 13, 2020
- Sex
- Male
- 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 | 124484 | MN | Primary |
Addresses
Primary practice location
1610 Monks Ave
Mankato, MN 56001-5173
Mailing address
PO Box 391
Eagle Lake, MN 56024-0391
Phone (605) 553-6651
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 |
|---|---|---|---|
| 124484 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand St Paul CVS LLC | Past | Accepting new patients | |
| Grand St Paul CVS LLC | Past | Accepting new patients |
Organizations & group practices 2
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": "1584057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584057600000",
"number": "1902432727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 391",
"city": "EAGLE LAKE",
"state": "MN",
"postal_code": "560240391",
"telephone_number": "605-553-6651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1610 MONKS AVE",
"city": "MANKATO",
"state": "MN",
"postal_code": "560015173",
"telephone_number": "507-625-1553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN PEURSEM",
"first_name": "NICHOLAS",
"middle_name": "ALLEN",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-13",
"last_updated": "2020-03-13",
"certification_date": "2020-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "124484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mankato, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.