Active NPI
United Community Pharmacy Corporation
- Long Term Care Pharmacy
- St Anthony, MN
National Provider Identifier
1962037242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Pharmacy
- Legal business name
- UNITED COMMUNITY PHARMACY CORPORATION
- Practice address
- 2500 Highway 88 Ste 105
St Anthony, MN 55418-4138 - Phone
- (612) 259-8275
- Fax
- (612) 259-8286
- NPI assigned
- Mar 7, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David Yesilevskiy
- Title
- Director of Operations
- Phone
- (612) 259-8275
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Pharmacy | 3336L0003X | Primary |
Addresses
Primary practice location
2500 Highway 88 Ste 105
St Anthony, MN 55418-4138
Mailing address
2500 Highway 88 Ste 105
St Anthony, MN 55418-4138
Phone (612) 259-8275
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 715415000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231218000143 | MN | Part B Supplier - Pharmacy | 7719336627 |
1 other NPI on this enrollment Practice locations: Golden Valley, MN |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community/Retail Pharmacy
- Saint Anthony, MN
- NPI 1982924288
O20231218000143
National Provider Directory
National Provider Directory- Tax ID family
- United Community Pharmacy Corporation
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Durable Medical Equipment & Medical Supplies
- Saint Anthony, MN
- NPI 1588530604
-
- Community/Retail Pharmacy
- Saint Anthony, MN
- NPI 1982924288
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583539200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1583539200000",
"number": "1962037242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 HIGHWAY 88 STE 105",
"city": "ST ANTHONY",
"state": "MN",
"postal_code": "554184138",
"telephone_number": "612-259-8275",
"fax_number": "612-259-8286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 HIGHWAY 88 STE 105",
"city": "ST ANTHONY",
"state": "MN",
"postal_code": "554184138",
"telephone_number": "612-259-8275",
"fax_number": "612-259-8286"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UNITED COMMUNITY PHARMACY CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2020-03-07",
"last_updated": "2020-03-07",
"certification_date": "2020-03-07",
"status": "A",
"authorized_official_last_name": "YESILEVSKIY",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
"authorized_official_telephone_number": "612-259-8275",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3336L0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Long Term Care Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "715415000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Anthony, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.