Derek Bryan Anderson, PHARMD
Individual provider Active NPI Pharmacist · Owatonna, MN
NPI 1902572076 · NPPES record last updated Aug 19, 2021
Key facts
- NPI
- 1902572076
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 125261 (MN)
- Practice address
- 1130 W Frontage Rd
Owatonna, MN 55060-5662 - Phone
- (507) 451-3323
- NPI assigned
- Aug 19, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125261 | MN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 125261 | MN | Yes |
Addresses
Primary practice location
1130 W Frontage Rd
Owatonna, MN 55060-5662
Mailing address
2431 Jefferson Rd
Apt 110
Northfield, MN 55057
Phone (507) 469-2166
Other providers in Owatonna, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.