Active NPI
Brandon Hataye
- Pharmacist
- Robbinsdale, MN
National Provider Identifier
1942891106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 125001
- Practice address
- 4100 W Broadway Ave
Robbinsdale, MN 55422 - Phone
- (763) 537-9487
- Fax
- (763) 537-0008
- NPI assigned
- Jan 31, 2021
- Last updated
- May 16, 2023
- Sex
- Male
- Sole proprietor
- No
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 | 125001 | MN | Primary |
Addresses
Primary practice location
4100 W Broadway Ave
Robbinsdale, MN 55422
Mailing address
4100 W Broadway Ave
Robbinsdale, MN 55422-1809
Phone (763) 537-9487
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125001 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
4100 W Broadway Ave
Robbinsdale, MN 55422
Phone (763) 537-9487
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": "1612051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684195200000",
"number": "1942891106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 W BROADWAY AVE",
"city": "ROBBINSDALE",
"state": "MN",
"postal_code": "554221809",
"telephone_number": "763-537-9487",
"fax_number": "763-537-0008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 W BROADWAY AVE",
"city": "ROBBINSDALE",
"state": "MN",
"postal_code": "55422",
"telephone_number": "763-537-9487",
"fax_number": "763-537-0008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATAYE",
"first_name": "BRANDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-31",
"last_updated": "2023-05-16",
"certification_date": "2023-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "125001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Robbinsdale, MN
- Laura Kristen Hanvelt, PA-C
- Matthew Brian Hartz, MD, MPH
- Hass Enterprises, Inc. (North Drug)
- James Baxter Hass, R. PH.
- Kristen Kathleen Hasson, M.D.
- Rolf Severin Hauck, M.D.
- Darko Hauer, MD
- Luke Thomas Hawes, M.D.
- Gwendolyn Hayes, RDN, LD
- Health Activation Services, PLLC (NorthWorks Occupational Health)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.